Provider Demographics
NPI:1205318391
Name:WILLPOWER LLC
Entity type:Organization
Organization Name:WILLPOWER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:O
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-574-4400
Mailing Address - Street 1:124 KIMBROUGH BLVD BLDG Q
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-4307
Mailing Address - Country:US
Mailing Address - Phone:318-574-4400
Mailing Address - Fax:318-574-4400
Practice Address - Street 1:124 KIMBROUGH BLVD BLDG Q
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-4307
Practice Address - Country:US
Practice Address - Phone:318-574-4400
Practice Address - Fax:318-574-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty