Healthcare Provider Details

I. General information

NPI: 1336261148
Provider Name (Legal Business Name): WILLOW CREEK CENTERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41677 FORD ROAD SUITE A
CANTON MI
48187
US

IV. Provider business mailing address

41677 FORD ROAD SUITE A
CANTON MI
48187
US

V. Phone/Fax

Practice location:
  • Phone: 734-987-3100
  • Fax: 734-981-6366
Mailing address:
  • Phone: 734-987-3100
  • Fax: 734-981-6366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JAMES LON ANTHONY
Title or Position: PRESIDENT
Credential: PHD
Phone: 734-981-3100