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General NPI Number Information
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NPI Number | 1093520272
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Entity Type | Organization
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Legal Business Name | WILLOW WELLNESS, LLC
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 761 LAGOON DR
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City | OVIEDO
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State | FL
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Zip | 32765-8408
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Country | US
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Telephone | 407-906-5715
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Fax |
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Provider Business Mailing Address
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Address Line | 761 LAGOON DR
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City | OVIEDO
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State | FL
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Zip | 32765-8408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YISLEN FELIPES
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Credential | MA, LMHC, NCC
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Telephone | 407-906-5715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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