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General NPI Number Information
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NPI Number | 1114884384
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Entity Type | Organization
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Legal Business Name | WILLOW TREE THERAPY, LLC.
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 3900 INGERSOLL AVE STE 108
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City | DES MOINES
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State | IA
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Zip | 50312-3535
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Country | US
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Telephone | 515-650-1809
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Fax |
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Provider Business Mailing Address
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Address Line | 130 LAKE SHORE DR
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City | DALLAS CENTER
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State | IA
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Zip | 50063-2068
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Country | US
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Telephone | 515-650-1809
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | JACY NICOLE JENSEN
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Credential | LMFT
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Telephone | 515-571-0113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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