Provider Demographics
NPI:1023301512
Name:WILLS, CERISSA JEAN (LMFT)
Entity type:Individual
Prefix:MS
First Name:CERISSA
Middle Name:JEAN
Last Name:WILLS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 INTERNATIONAL LN STE 207
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3152
Mailing Address - Country:US
Mailing Address - Phone:608-228-4610
Mailing Address - Fax:
Practice Address - Street 1:831 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2935
Practice Address - Country:US
Practice Address - Phone:608-255-7356
Practice Address - Fax:608-255-0457
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI871124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist