Provider Demographics
NPI:1013784578
Name:BYAS, WILLIS (LLMSW)
Entity type:Individual
Prefix:
First Name:WILLIS
Middle Name:
Last Name:BYAS
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8564 W CAMPUS CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-9527
Mailing Address - Country:US
Mailing Address - Phone:917-342-4626
Mailing Address - Fax:
Practice Address - Street 1:8564 W CAMPUS CIRCLE DR
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-9527
Practice Address - Country:US
Practice Address - Phone:917-342-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511175221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical