Provider Demographics
NPI:1134733868
Name:THE WILLOW CENTER FOR INTEGRATIVE HEALTH PLLC
Entity type:Organization
Organization Name:THE WILLOW CENTER FOR INTEGRATIVE HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LINDSAY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MS
Authorized Official - Phone:312-504-7567
Mailing Address - Street 1:3543 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3945
Mailing Address - Country:US
Mailing Address - Phone:312-504-7567
Mailing Address - Fax:312-448-8574
Practice Address - Street 1:3543 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3945
Practice Address - Country:US
Practice Address - Phone:312-504-7567
Practice Address - Fax:312-448-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1184941437OtherNPI
IL1194197749OtherNPI
IL1073022547OtherNPI
IL1457822801OtherNPI