Provider Demographics
NPI:1043830334
Name:THE WILLOWS COUNSELING AND EMDR CENTER, LLC
Entity Type:Organization
Organization Name:THE WILLOWS COUNSELING AND EMDR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-IT, CSAC
Authorized Official - Phone:608-851-0348
Mailing Address - Street 1:20759 BURR OAK RD
Mailing Address - Street 2:
Mailing Address - City:CAPRON
Mailing Address - State:IL
Mailing Address - Zip Code:61012-9616
Mailing Address - Country:US
Mailing Address - Phone:815-482-2563
Mailing Address - Fax:815-737-8115
Practice Address - Street 1:20 S MAIN ST STE 21
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-3959
Practice Address - Country:US
Practice Address - Phone:608-851-0348
Practice Address - Fax:815-737-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-16
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100078408Medicaid