Provider Demographics
NPI:1750908240
Name:WILLOW TREE THERAPY
Entity type:Organization
Organization Name:WILLOW TREE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:317-649-8738
Mailing Address - Street 1:1040 E 86TH ST STE 44C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1856
Mailing Address - Country:US
Mailing Address - Phone:317-649-8738
Mailing Address - Fax:317-342-5145
Practice Address - Street 1:1040 E 86TH ST STE 44C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1856
Practice Address - Country:US
Practice Address - Phone:317-649-8738
Practice Address - Fax:317-342-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty