Provider Demographics
NPI:1821729369
Name:WILLOW BRANCH COUNSELING GROUP LLC
Entity Type:Organization
Organization Name:WILLOW BRANCH COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINNEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-919-8505
Mailing Address - Street 1:35560 GRAND RIVER AVE STE 181
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3123
Mailing Address - Country:US
Mailing Address - Phone:248-919-8505
Mailing Address - Fax:
Practice Address - Street 1:32729 GRAND RIVER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:248-919-8505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health