Provider Demographics
NPI:1023300720
Name:WILLOW BEND CENTER
Entity type:Organization
Organization Name:WILLOW BEND CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:FLORENCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-596-8900
Mailing Address - Street 1:2902 STATE HIGHWAY 31 E
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8613
Mailing Address - Country:US
Mailing Address - Phone:903-596-8900
Mailing Address - Fax:903-596-8903
Practice Address - Street 1:2902 STATE HIGHWAY 31 E
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8613
Practice Address - Country:US
Practice Address - Phone:903-596-8900
Practice Address - Fax:903-596-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty