Individual
JOHN GLEN WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
1030 JOHNSON RD STE 286, GOLDEN, CO 80401-6003
(720) 220-4187
Mailing address
1030 JOHNSON RD STE 286, GOLDEN, CO 80401-6003
(720) 220-4187
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6334
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14467331
CAQH
CO
Enumeration date
12/09/2008
Last updated
05/10/2019
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