Healthcare Provider Details

I. General information

NPI: 1558294629
Provider Name (Legal Business Name): WILLOW PATH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9905 S PENNSYLVANIA AVE STE A
OKLAHOMA CITY OK
73159-6920
US

IV. Provider business mailing address

9905 S PENNSYLVANIA AVE STE A
OKLAHOMA CITY OK
73159-6920
US

V. Phone/Fax

Practice location:
  • Phone: 405-346-9876
  • Fax:
Mailing address:
  • Phone: 405-346-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HUNTER WANT
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 405-346-9876