Willcox, Mary Teresa

Willcox, Mary Teresa is an sole proprietor health care provider with primary practice located at 1525 Fullilove Dr , Bossier City LA 71112-3346. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Willcox, Mary Teresa can be contacted via phone (318) 747-1211.

Contact Information

Primary practice address
1525 Fullilove Dr Bossier City LA 71112-3346
Phone: (318) 747-1211
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 3259 Louisiana

Profile Details

NPI number 1679084925
LBN Legal business name Willcox, Mary Teresa
Credentials CIT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 13th, 2017
Last updated Oct 13th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679084925 NPPES
Louisiana MEDICAID 1699955815

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