Provider Demographics
NPI:1013279959
Name:THE WILLOWS COUNSELING SERVICES
Entity Type:Organization
Organization Name:THE WILLOWS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-735-9755
Mailing Address - Street 1:874 SHIRLEY LN
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-3627
Mailing Address - Country:US
Mailing Address - Phone:702-735-9755
Mailing Address - Fax:702-367-9089
Practice Address - Street 1:8665 W FLAMINGO RD
Practice Address - Street 2:STE 2000
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8621
Practice Address - Country:US
Practice Address - Phone:702-735-9755
Practice Address - Fax:702-367-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC20120612-2476251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1629161443Medicaid