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General NPI Number Information
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NPI Number | 1154437739
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Entity Type | Organization
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Legal Business Name | WILLOW WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 2604 DEMPSTER ST STE 401
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City | PARK RIDGE
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State | IL
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Zip | 60068-8428
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Country | US
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Telephone | 847-318-8200
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Fax | 224-478-0026
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Provider Business Mailing Address
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Address Line | 2604 DEMPSTER ST STE 402
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City | PARK RIDGE
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State | IL
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Zip | 60068-8438
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Country | US
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Telephone | 847-318-8200
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Fax | 224-478-0026
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | DR. LISA CECILIA CAMPBELL
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Credential | PSY.D.
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Telephone | 847-318-8200
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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