Provider Demographics
NPI:1790093581
Name:WILLS, PATRICE ROZELL (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:ROZELL
Last Name:WILLS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 AUSTIN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1511
Mailing Address - Country:US
Mailing Address - Phone:254-744-1412
Mailing Address - Fax:254-732-7180
Practice Address - Street 1:2424 AUSTIN AVE STE 204
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1511
Practice Address - Country:US
Practice Address - Phone:254-744-1412
Practice Address - Fax:254-732-7180
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1566192Medicaid