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General NPI Number Information
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NPI Number | 1124519764
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Entity Type | Organization
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Legal Business Name | WILLOW CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 2150 MANCHESTER RD STE 110
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City | WHEATON
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State | IL
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Zip | 60187-2474
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Country | US
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Telephone | 630-752-9874
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Fax | 630-752-9875
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Provider Business Mailing Address
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Address Line | 2150 MANCHESTER RD STE 110
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City | WHEATON
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State | IL
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Zip | 60187-2474
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Country | US
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Telephone | 708-955-1388
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Fax | 630-752-9875
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA L REETZ
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Credential | MA, LCPC
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Telephone | 708-955-1388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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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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