Provider Demographics
NPI:1942808712
Name:WILLOW TREE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:WILLOW TREE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLASIUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-995-8512
Mailing Address - Street 1:613 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5031
Mailing Address - Country:US
Mailing Address - Phone:303-995-8512
Mailing Address - Fax:
Practice Address - Street 1:613 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5031
Practice Address - Country:US
Practice Address - Phone:303-995-8512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLOW TREE COUNSELING SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty