Provider Demographics
NPI:1659240133
Name:WILLOW BROOK COUNSELING AND WELLNESS, PLLC
Entity type:Organization
Organization Name:WILLOW BROOK COUNSELING AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAYTHE
Authorized Official - Middle Name:REYHAN
Authorized Official - Last Name:FLINN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-308-2440
Mailing Address - Street 1:11859 N CR 1650E
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:IL
Mailing Address - Zip Code:62644-6890
Mailing Address - Country:US
Mailing Address - Phone:217-308-2440
Mailing Address - Fax:217-771-1670
Practice Address - Street 1:11859 N CR 1650E
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:IL
Practice Address - Zip Code:62644-6890
Practice Address - Country:US
Practice Address - Phone:217-308-2440
Practice Address - Fax:217-771-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty