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General NPI Number Information
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NPI Number | 1205704236
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Entity Type | Organization
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Legal Business Name | FERN & WILLOW COUNSELING, LLC
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 202 S CEDAR ST STE B
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City | OWASSO
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State | OK
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Zip | 74055-3451
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Country | US
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Telephone | 918-521-1594
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 752
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City | OWASSO
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State | OK
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Zip | 74055-0752
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Country | US
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Telephone | 918-521-1594
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Fax |
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Authorized Official
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Title or Position | OWNER/SOLO PRACTITIONER
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Name | AMANDA RACHELLE PEEVSASSER
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Credential | LCSW
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Telephone | 918-521-1594
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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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