Provider Demographics
NPI:1447878400
Name:WILLMORE, ANDY
Entity type:Individual
Prefix:MR
First Name:ANDY
Middle Name:
Last Name:WILLMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4185 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3011
Mailing Address - Country:US
Mailing Address - Phone:614-595-7729
Mailing Address - Fax:
Practice Address - Street 1:550 S CLEVELAND AVE # 8G
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8958
Practice Address - Country:US
Practice Address - Phone:614-595-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician