Provider Demographics
NPI:1205159332
Name:WILLOW TREE COUNSELING, P.S.
Entity type:Organization
Organization Name:WILLOW TREE COUNSELING, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAUNI
Authorized Official - Middle Name:
Authorized Official - Last Name:TREECE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-890-6709
Mailing Address - Street 1:PO BOX 2742
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-0742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 MORRIS AVE S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2521
Practice Address - Country:US
Practice Address - Phone:206-890-6709
Practice Address - Fax:425-458-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB09087Medicare PIN