Provider Demographics
NPI:1760608517
Name:WILLIS, KAREN JANE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JANE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:JANE
Other - Last Name:LANDOSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2522 WOODCHASE CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-7118
Mailing Address - Country:US
Mailing Address - Phone:248-928-3029
Mailing Address - Fax:
Practice Address - Street 1:2 CROCKER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2558
Practice Address - Country:US
Practice Address - Phone:586-468-2266
Practice Address - Fax:586-468-4505
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010852041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical