| Doctor Name: | MR. GRANT THOMAS WILLMS |
| NPI Number: | 1376850016 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.MIN. |
| License Number: | 04986 |
| Business Practice Address: | 20 Frank St Council Bluffs, IA - 515034460 |
| Business Phone Number: | 7123234478 |
| Business Fax Number: | 7123234188 |
| Mailing Address: | 2132 S 42nd St, OMAHA |
| State: | NE |
| Postal Code: | 681052910 |
| Phone Number: | 4025581858 |
| Fax Number: | 4025588970 |
| NPI Enumeration Date: | 09/01/2010 |
| NPI Last Update Date: | 09/01/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 04986 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |