Provider Demographics
NPI:1912776253
Name:WILLOW COUNSELING AND THERAPEUTIC ARTS CENTER, LLC
Entity Type:Organization
Organization Name:WILLOW COUNSELING AND THERAPEUTIC ARTS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIBERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-426-8910
Mailing Address - Street 1:615 N SHERMAN AVE STE 24
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4457
Mailing Address - Country:US
Mailing Address - Phone:608-445-2510
Mailing Address - Fax:262-293-9777
Practice Address - Street 1:615 N SHERMAN AVE STE 24
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4457
Practice Address - Country:US
Practice Address - Phone:608-445-2510
Practice Address - Fax:262-293-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty