Provider Demographics
NPI:1558736041
Name:WILLOW OAK COUNSELING, LLC
Entity Type:Organization
Organization Name:WILLOW OAK COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:BURKE
Authorized Official - Last Name:COTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:502-882-0225
Mailing Address - Street 1:125 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4905
Mailing Address - Country:US
Mailing Address - Phone:502-882-0225
Mailing Address - Fax:
Practice Address - Street 1:125 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4905
Practice Address - Country:US
Practice Address - Phone:502-882-0225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMFTMFT00223555101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty