Provider Demographics
NPI:1043516495
Name:A WILLOW BENDS, LLC
Entity Type:Organization
Organization Name:A WILLOW BENDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, CACIII
Authorized Official - Phone:719-442-1883
Mailing Address - Street 1:316 E SAINT VRAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1124
Mailing Address - Country:US
Mailing Address - Phone:719-442-1883
Mailing Address - Fax:719-448-8522
Practice Address - Street 1:316 E SAINT VRAIN ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1124
Practice Address - Country:US
Practice Address - Phone:719-442-1883
Practice Address - Fax:719-448-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty