Provider Demographics
NPI:1497293799
Name:WILLOW TREE COUNSELING, PLLC
Entity Type:Organization
Organization Name:WILLOW TREE COUNSELING, PLLC
Other - Org Name:WILLOW TREE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC LAC
Authorized Official - Phone:701-730-8313
Mailing Address - Street 1:102 W BEATON DR STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2653
Mailing Address - Country:US
Mailing Address - Phone:701-730-8313
Mailing Address - Fax:701-552-7975
Practice Address - Street 1:102 W BEATON DR STE 103
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2653
Practice Address - Country:US
Practice Address - Phone:701-730-8313
Practice Address - Fax:701-552-7975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 261QR0405X
ND699-10-1-11-238251S00000X
ND1650251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder