Individual
MR. BRIAN E WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
5642 JONES ST, MILTON, FL 32570-2304
(850) 626-7779
(850) 626-7171
Mailing address
5642 JONES ST, MILTON, FL 32570-2304
(850) 626-7779
(850) 626-7171
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
MH 11927
FL
101YM0800X
Mental Health Counselor
Primary
MH11927
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101566900
—
FL
Enumeration date
08/27/2012
Last updated
08/12/2022
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