Healthcare Provider Details

I. General information

NPI: 1750848784
Provider Name (Legal Business Name): WILLOW TREE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 06/26/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W LA RUA ST
PENSACOLA FL
32501-3933
US

IV. Provider business mailing address

3620 GOYA CT
PENSACOLA FL
32504-4522
US

V. Phone/Fax

Practice location:
  • Phone: 850-206-4845
  • Fax: 850-665-3288
Mailing address:
  • Phone: 850-206-4845
  • Fax: 850-438-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA WATSON
Title or Position: OWNER/MANAGER
Credential: LCSW
Phone: 850-206-4845