Provider Demographics
NPI:1659590446
Name:WILLETT, JODI R (PCC)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:R
Last Name:WILLETT
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:MS
Other - First Name:JODI
Other - Middle Name:R
Other - Last Name:HURLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PC
Mailing Address - Street 1:151 MARION AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-2223
Mailing Address - Country:US
Mailing Address - Phone:419-774-9969
Mailing Address - Fax:419-756-5642
Practice Address - Street 1:151 MARION AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2223
Practice Address - Country:US
Practice Address - Phone:419-774-9969
Practice Address - Fax:419-756-5642
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
OH101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist