Individual
LAURA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30826 LINDER RD, DENHAM SPRINGS, LA 70726-8507
(225) 955-0284
Mailing address
630 E CHUCK ST, GONZALES, LA 70737-4434
(225) 955-0284
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548839
—
LA
Enumeration date
09/27/2016
Last updated
09/27/2016
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