Provider Demographics
NPI:1578727616
Name:CURTIS E WILLS, PC
Entity Type:Organization
Organization Name:CURTIS E WILLS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:409-729-0400
Mailing Address - Street 1:2300 HIGHWAY 365
Mailing Address - Street 2:110
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6256
Mailing Address - Country:US
Mailing Address - Phone:409-729-0400
Mailing Address - Fax:
Practice Address - Street 1:2300 HIGHWAY 365
Practice Address - Street 2:110
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6256
Practice Address - Country:US
Practice Address - Phone:409-729-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21163103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196750701Medicaid