Provider Demographics
NPI:1427891647
Name:WILLS, KRISTIN R (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:WILLS
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 LAKE CREST DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-4302
Mailing Address - Country:US
Mailing Address - Phone:337-244-9175
Mailing Address - Fax:
Practice Address - Street 1:1409 KIRKMAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5344
Practice Address - Country:US
Practice Address - Phone:337-385-0059
Practice Address - Fax:337-385-0469
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional