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:
Health care specialties
| Specialty | Code | License # | 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 7 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1679084925 | NPPES |
| Louisiana | MEDICAID | 1699955815 |
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