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General NPI Number Information
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NPI Number | 1144722059
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Entity Type | Organization
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Legal Business Name | WILLOW TREE THERAPY
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Dates
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Enumeration Date | 03/06/2018
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 100 WARREN AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3728
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Country | US
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Telephone | 307-682-2034
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Fax |
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Provider Business Mailing Address
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Address Line | 100 WARREN AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3728
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Country | US
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Telephone | 307-682-2034
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Fax | 307-682-2968
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Authorized Official
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Title or Position | OWNER
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Name | POLLY J AKINS
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Credential | LPC
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Telephone | 307-682-2034
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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 | LPC
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License Number State | WY
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