Provider Demographics
NPI:1013159631
Name:WILLOW FAMILY THERAPY INC
Entity type:Organization
Organization Name:WILLOW FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:650-355-0841
Mailing Address - Street 1:80 EUREKA SQ
Mailing Address - Street 2:SUITE 216
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2654
Mailing Address - Country:US
Mailing Address - Phone:650-355-0841
Mailing Address - Fax:
Practice Address - Street 1:80 EUREKA SQ
Practice Address - Street 2:SUITE 216
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2654
Practice Address - Country:US
Practice Address - Phone:650-355-0841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty