Provider Demographics
NPI:1801693114
Name:WILLIS, BILAL HANEEF (CAMS-1, RCP-F, CPC,)
Entity type:Individual
Prefix:
First Name:BILAL
Middle Name:HANEEF
Last Name:WILLIS
Suffix:
Gender:
Credentials:CAMS-1, RCP-F, CPC,
Other - Prefix:
Other - First Name:COACH B
Other - Middle Name:
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7026 BAILEY ST SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5020
Mailing Address - Country:US
Mailing Address - Phone:360-481-9663
Mailing Address - Fax:
Practice Address - Street 1:7026 BAILEY ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-5020
Practice Address - Country:US
Practice Address - Phone:360-481-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101Y00000X, 175T00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty