Provider Demographics
NPI:1558837427
Name:WILLOW TREE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:WILLOW TREE COUNSELING SERVICES LLC
Other - Org Name:WILLOW TREE COUNSELING SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLASIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:303-995-8512
Mailing Address - Street 1:3954 YOUNGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-3865
Mailing Address - Country:US
Mailing Address - Phone:303-995-8512
Mailing Address - Fax:
Practice Address - Street 1:3954 YOUNGFIELD ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-3865
Practice Address - Country:US
Practice Address - Phone:303-995-8512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty