Provider Demographics
NPI:1629204011
Name:WILLING, NEAL KENNETH (LPC)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:KENNETH
Last Name:WILLING
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:MI
Mailing Address - Zip Code:49287-9734
Mailing Address - Country:US
Mailing Address - Phone:517-456-6353
Mailing Address - Fax:517-456-4894
Practice Address - Street 1:4709 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:MI
Practice Address - Zip Code:49287-9734
Practice Address - Country:US
Practice Address - Phone:517-456-6353
Practice Address - Fax:517-456-4894
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-31
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003147101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional