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General NPI Number Information
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NPI Number | 1356004121
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Entity Type | Organization
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Legal Business Name | WILLOW GROVE COUNSELING
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 128 W 900 N STE C
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City | SPANISH FORK
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State | UT
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Zip | 84660-1463
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Country | US
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Telephone | 385-200-0445
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Fax |
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Provider Business Mailing Address
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Address Line | 128 W 900 N STE C
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City | SPANISH FORK
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State | UT
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Zip | 84660-1463
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Country | US
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Telephone | 385-200-0445
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | BROOKE WILLIS
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Credential | LCSW
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Telephone | 385-200-0445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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