Healthcare Provider Details

I. General information

NPI: 1346155678
Provider Name (Legal Business Name): WILLOW TREE PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17620 DURANT ST NE
HAM LAKE MN
55304-4602
US

IV. Provider business mailing address

17620 DURANT ST NE
HAM LAKE MN
55304-4602
US

V. Phone/Fax

Practice location:
  • Phone: 612-567-2501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CLAIRE BAUMGARTNER
Title or Position: PSYCHOTHERAPIST
Credential: LICSW
Phone: 303-908-1049