Provider Demographics
NPI:1992233746
Name:WILLIS, JESSICA K (MA, BCCC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:K
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MA, BCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 RIVER BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2280
Mailing Address - Country:US
Mailing Address - Phone:1615-210-1461
Mailing Address - Fax:
Practice Address - Street 1:100 HAZEL PATH
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3841
Practice Address - Country:US
Practice Address - Phone:615-210-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health