Provider Demographics
NPI:1750192050
Name:WILLOW WELLBEING, LLC
Entity type:Organization
Organization Name:WILLOW WELLBEING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD
Authorized Official - Phone:763-233-1298
Mailing Address - Street 1:6417 PENN AVE S STE 7-1440
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6417 PENN AVE S STE 7-1440
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55423-1186
Practice Address - Country:US
Practice Address - Phone:763-233-1298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty