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Individual

MR. CHARLES STEPHEN WILLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.MFT

Contact information

Practice address
500 CHESTNUT ST, STE. 1001, ABILENE, TX 79602-1453
(325) 437-1001
(325) 437-1005
Mailing address
PO BOX 3711, ABILENE, TX 79604-3711
(325) 437-1001
(325) 437-1005

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
9937
TX
106H00000X
Marriage & Family Therapist
1800
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0262651-01
TX
01
2617LC
BLUECROSS/BLUESHIELD
Enumeration date
10/19/2006
Last updated
12/09/2021
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