Healthcare Provider Details

I. General information

NPI: 1629904545
Provider Name (Legal Business Name): WILLOW TREE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 VIKING ST
COON VALLEY WI
54623-8337
US

IV. Provider business mailing address

94 VIKING ST
COON VALLEY WI
54623-8337
US

V. Phone/Fax

Practice location:
  • Phone: 608-606-2812
  • Fax:
Mailing address:
  • Phone: 608-606-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TERESA LYNN NUNDAHL
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: M.S.
Phone: 608-606-2812