Provider Demographics
NPI:1982389599
Name:WILLIE, TERMAYNE (LMSW)
Entity Type:Individual
Prefix:
First Name:TERMAYNE
Middle Name:
Last Name:WILLIE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 MEYER WAY APT 7156
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1501
Mailing Address - Country:US
Mailing Address - Phone:940-473-1945
Mailing Address - Fax:
Practice Address - Street 1:102 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2949
Practice Address - Country:US
Practice Address - Phone:972-292-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health