Healthcare Provider Details

I. General information

NPI: 1093520272
Provider Name (Legal Business Name): WILLOW WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3574 NW 13TH ST
MIAMI FL
33125-2817
US

IV. Provider business mailing address

3574 NW 13TH ST
MIAMI FL
33125-2817
US

V. Phone/Fax

Practice location:
  • Phone: 407-906-5715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: YISLEN FELIPES
Title or Position: CEO
Credential: MA, LMHC, NCC
Phone: 407-906-5715