Healthcare Provider Details

I. General information

NPI: 1356004121
Provider Name (Legal Business Name): WILLOW GROVE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 09/11/2025
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W 900 N STE C
SPANISH FORK UT
84660-1463
US

IV. Provider business mailing address

128 W 900 N STE C
SPANISH FORK UT
84660-1463
US

V. Phone/Fax

Practice location:
  • Phone: 385-200-0445
  • Fax:
Mailing address:
  • Phone: 385-200-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BROOKE WILLIS
Title or Position: CO-OWNER
Credential: LCSW
Phone: 385-200-0445