Provider Demographics
NPI:1699107607
Name:WILLIS, DANIELLE GENO (LCSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:GENO
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 29TH ST
Mailing Address - Street 2:237
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7804
Mailing Address - Country:US
Mailing Address - Phone:970-685-2647
Mailing Address - Fax:
Practice Address - Street 1:150 E 29TH ST
Practice Address - Street 2:237
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-7804
Practice Address - Country:US
Practice Address - Phone:970-685-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099230221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical