Provider Demographics
NPI:1922620640
Name:WILLOW RIDGE THERAPY, LLC
Entity Type:Organization
Organization Name:WILLOW RIDGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:STILES-BEECHEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:989-859-4472
Mailing Address - Street 1:1163 S MAIN ST # 157
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1408
Mailing Address - Country:US
Mailing Address - Phone:989-859-4472
Mailing Address - Fax:
Practice Address - Street 1:2532 WHEELER DR
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-9224
Practice Address - Country:US
Practice Address - Phone:989-859-4472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health