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General NPI Number Information
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NPI Number | 1366322117
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Entity Type | Organization
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Legal Business Name | THREE WILLOWS HEALING
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 119 GARDEN ST
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City | PRESCOTT
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State | AZ
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Zip | 86305-2905
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Country | US
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Telephone | 928-848-8897
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Fax |
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Provider Business Mailing Address
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Address Line | 981 N LATIGO LN
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City | DEWEY
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State | AZ
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Zip | 86327-5831
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Country | US
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Telephone | 928-848-8897
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | AMANDA JOAN ELISEO
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Credential | LPC
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Telephone | --
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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 |
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License Number State |
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