Provider Demographics
NPI:1922411198
Name:WILLOW CREEK COUNSELING
Entity Type:Organization
Organization Name:WILLOW CREEK COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLPC
Authorized Official - Phone:248-250-0140
Mailing Address - Street 1:12795 FOUNTAIN SQ
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-9991
Mailing Address - Country:US
Mailing Address - Phone:248-250-0140
Mailing Address - Fax:
Practice Address - Street 1:12795 FOUNTAIN SQ
Practice Address - Street 2:
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-9991
Practice Address - Country:US
Practice Address - Phone:248-250-0140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014143251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health