Provider Demographics
NPI:1912415084
Name:WILLS, LOUISE RUTH HARPER (LISW-S, CCM)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:RUTH HARPER
Last Name:WILLS
Suffix:
Gender:F
Credentials:LISW-S, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5162 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1571
Mailing Address - Country:US
Mailing Address - Phone:216-039-6829
Mailing Address - Fax:216-465-3158
Practice Address - Street 1:5162 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1571
Practice Address - Country:US
Practice Address - Phone:216-938-6829
Practice Address - Fax:216-465-3158
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI4734101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health