Provider Demographics
NPI:1396203634
Name:WILLOW COUNSELING & WELLNESS, LLC
Entity Type:Organization
Organization Name:WILLOW COUNSELING & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, RPT
Authorized Official - Phone:214-842-2898
Mailing Address - Street 1:4925 OAK HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4406
Mailing Address - Country:US
Mailing Address - Phone:214-842-2898
Mailing Address - Fax:
Practice Address - Street 1:4100 SPRING VALLEY RD STE 674
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3629
Practice Address - Country:US
Practice Address - Phone:469-340-1116
Practice Address - Fax:844-496-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty