Active NPI
John Glen Willis, MA, LPC
- Mental Health Counselor
- Golden, CO
National Provider Identifier
1700021425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6334
- Practice address
- 1030 Johnson Rd Ste 286
Golden, CO 80401-6003 - Phone
- (720) 220-4187
- NPI assigned
- Dec 9, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6334 | CO | Primary |
Addresses
Primary practice location
1030 Johnson Rd Ste 286
Golden, CO 80401-6003
Mailing address
1030 Johnson Rd Ste 286
Golden, CO 80401-6003
Phone (720) 220-4187
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14467331 | Other | CO | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6334 | CO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557446400000",
"number": "1700021425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1030 JOHNSON RD STE 286",
"city": "GOLDEN",
"state": "CO",
"postal_code": "804016003",
"telephone_number": "720-220-4187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 JOHNSON RD STE 286",
"city": "GOLDEN",
"state": "CO",
"postal_code": "804016003",
"telephone_number": "720-220-4187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "JOHN",
"middle_name": "GLEN",
"credential": "MA, LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-09",
"last_updated": "2019-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CO",
"license": "6334",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "14467331",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Golden, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.