NPI Code Detail JSON Logo

1114884384 NPI number — WILLOW TREE THERAPY, LLC.

NPI Number: 1114884384
Health Care Provider/Practitioner: WILLOW TREE THERAPY, LLC.

Information about “1114884384” NPI (WILLOW TREE THERAPY, LLC.) exists in 1114884384 in HTML format HTML  |  1114884384 in plain Text format TXT  |  1114884384 in PDF (Portable Document Format) PDF  |  1114884384 in an XML format XML  formats.

NPI Number : 1114884384 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114884384",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WILLOW TREE THERAPY, LLC.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "130 LAKE SHORE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS CENTER",
    "MailingAddressStateName": "IA",
    "MailingAddressPostalCode": "50063-2068",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "515-650-1809",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3900 INGERSOLL AVE STE 108",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DES MOINES",
    "PracticeLocationAddressStateName": "IA",
    "PracticeLocationAddressPostalCode": "50312-3535",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "515-650-1809",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/08/2026",
    "LastUpdateDate": "01/08/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JENSEN",
    "AuthorizedOfficialFirstName": "JACY",
    "AuthorizedOfficialMiddleName": "NICOLE",
    "AuthorizedOfficialTitle": "MARRIAGE AND FAMILY THERAPIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LMFT",
    "AuthorizedOfficialTelephoneNumber": "515-571-0113",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0801X",
        "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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