Healthcare Provider Details

I. General information

NPI: 1629788344
Provider Name (Legal Business Name): WILLOW TREE STUDIOS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 ANTELOPE RD
FORT COLLINS CO
80525-9679
US

IV. Provider business mailing address

2707 ANTELOPE RD
FORT COLLINS CO
80525-9679
US

V. Phone/Fax

Practice location:
  • Phone: 970-449-3460
  • Fax:
Mailing address:
  • Phone: 970-449-3460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: YVONNE HANNING
Title or Position: OWNER
Credential:
Phone: 970-449-3460