Individual
MARLA JEAN WILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34005109A
IN
1041C0700X
Clinical Social Worker
S19336
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118261
AMERICAID GROUP
TX
05
—
167121601
—
TX
01
—
237580JJJJ
MEDICARE
IN
01
—
P00649543
MEDICARE RR#
IN
Enumeration date
01/09/2006
Last updated
04/09/2012
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