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General NPI Number Information
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NPI Number | 1538611652
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Entity Type | Organization
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Legal Business Name | WILLOW SAGE SERVICES LLC
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 211 S WOODRUFF AVE STE A3
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4865
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Country | US
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Telephone | 208-524-4818
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Fax | 208-522-6630
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Provider Business Mailing Address
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Address Line | 211 S WOODRUFF AVE STE A3
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4865
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Country | US
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Telephone | 208-233-1276
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Fax | 208-233-0835
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TRESIA JONES
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Credential |
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Telephone | 208-233-1276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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