MEDICARE: WILLOW PATH THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1558294629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW PATH THERAPY LLC

Provider Business Mailing Address
First Line	:	9905 S PENNSYLVANIA AVE STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6920
Country	:	US
Telephone Number	:	405-346-9876
Fax Number	:

Provider Business Practice Location Address
First Line	:	9905 S PENNSYLVANIA AVE STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6920
Country	:	US
Telephone Number	:	405-346-9876
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	HUNTER WANT
Credential	:	LCSW
Telephone Number	:	405-346-9876

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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