Provider Demographics
NPI:1356004121
Name:WILLOW GROVE COUNSELING
Entity type:Organization
Organization Name:WILLOW GROVE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-200-0445
Mailing Address - Street 1:128 W 900 N STE C
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1463
Mailing Address - Country:US
Mailing Address - Phone:385-200-0445
Mailing Address - Fax:
Practice Address - Street 1:128 W 900 N STE C
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1463
Practice Address - Country:US
Practice Address - Phone:385-200-0445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health