Individual provider · NPI-1
Dr. Andrel M Willis, PhD, LE, LMT, Cht
Health & Wellness Coach · Park Forest, IL
NPI number1043765290
StatusActive
Last updated in NPPESNov 5, 2025
Details
- NPI
- 1043765290
- Entity type
- Individual (NPI-1)
- Name
- Dr. Andrel M Willis
- Credential
- PhD, LE, LMT, Cht
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 17, 2016
- Certification date
- Nov 5, 2025
- Last updated
- Nov 5, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171400000X | Health & Wellness Coach | – | – | Yes |
| 225700000X | Massage Therapist | 227017963 | IL | |
| 103T00000X | Psychologist | – | – | |
| 101YP2500X | Counselor, Professional | – | IL | |
| 101YP2500X | Counselor, Professional | – | – | |
| 103TM1800X | Psychologist, Intellectual & Developmental Disabilities | – | IL | |
| 101200000X | Drama Therapist | – | – | |
| 106S00000X | Behavior Technician | – | – |
Practice location
362 Wilshire StPark Forest, IL 60466-1514
Phone 815-790-0899
Mailing address
362 Wilshire StPark Forest, IL 60466-1514
Phone 815-790-0899
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