Healthcare Provider Details

I. General information

NPI: 1760232565
Provider Name (Legal Business Name): WILLOW ARTS & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 SHARON DR STE B
WESTLAKE OH
44145-7701
US

IV. Provider business mailing address

806 SHARON DR STE B
WESTLAKE OH
44145-7701
US

V. Phone/Fax

Practice location:
  • Phone: 440-539-2906
  • Fax:
Mailing address:
  • Phone: 440-539-2906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SARAH WALKER
Title or Position: TAX ID OWNER
Credential: LPCC
Phone: 440-539-2906