Provider Demographics
NPI:1639804578
Name:WILLOW TREE COUNSELING
Entity Type:Organization
Organization Name:WILLOW TREE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAGAT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-528-0959
Mailing Address - Street 1:2227 N ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-1809
Mailing Address - Country:US
Mailing Address - Phone:719-696-8426
Mailing Address - Fax:
Practice Address - Street 1:2227 N ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-1809
Practice Address - Country:US
Practice Address - Phone:719-696-8426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty