Healthcare Provider Details

I. General information

NPI: 1629530928
Provider Name (Legal Business Name): WILLOW TREE THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WILSON DR
SPARTA NJ
07871-3400
US

IV. Provider business mailing address

50 WILSON DR
SPARTA NJ
07871-3400
US

V. Phone/Fax

Practice location:
  • Phone: 908-246-0553
  • Fax:
Mailing address:
  • Phone: 908-246-0553
  • 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: EDWARD BLEVINS
Title or Position: PARTNER
Credential: LPC, LCADC, ACS
Phone: 908-246-0553