Provider Demographics
NPI:1336435098
Name:WILLIS, BILLIE DEAN JR
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:DEAN
Last Name:WILLIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 TAURUS DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5839
Mailing Address - Country:US
Mailing Address - Phone:405-503-4288
Mailing Address - Fax:
Practice Address - Street 1:1115 TAURUS DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5839
Practice Address - Country:US
Practice Address - Phone:405-503-4288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor