Healthcare Provider Details

I. General information

NPI: 1215715099
Provider Name (Legal Business Name): THE WILLOW COUNSELING COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 NIKLES DR STE 3
BOZEMAN MT
59715-2570
US

IV. Provider business mailing address

601 NIKLES DR STE 3
BOZEMAN MT
59715-2570
US

V. Phone/Fax

Practice location:
  • Phone: 406-521-7657
  • Fax:
Mailing address:
  • Phone: 406-521-7657
  • 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: KARA ERICKSON
Title or Position: OWNER
Credential:
Phone: 406-521-7657