| Doctor Name: | MR. TODD SPENCER WILLIS |
| NPI Number: | 1083604235 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.M.H.C., L.P.C. |
| License Number: | 39001592A |
| Business Practice Address: | 601 Wall St Valparaiso, IN - 463832512 |
| Business Phone Number: | 2195313500 |
| Business Fax Number: | |
| Mailing Address: | 424b Sequoia Dr, VALPARAISO |
| State: | IN |
| Postal Code: | 463858109 |
| Phone Number: | 2197598311 |
| Fax Number: | |
| NPI Enumeration Date: | 10/27/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 39001592A |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |