Healthcare Provider Details

I. General information

NPI: 1114128477
Provider Name (Legal Business Name): WILLOW SPRINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 EDISON WAY
RENO NV
89502-4100
US

IV. Provider business mailing address

650 EDISON WAY
RENO NV
89502-4100
US

V. Phone/Fax

Practice location:
  • Phone: 775-284-4717
  • Fax:
Mailing address:
  • Phone: 775-284-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. STEVE FILTON
Title or Position: CFO/SR VP
Credential:
Phone: 610-768-3300