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General NPI Number Information
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NPI Number | 1578022943
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Entity Type | Organization
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Legal Business Name | WILLOW FAMILY COUNSELING PLLC
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 03/25/2023
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Provider Practice Location Address
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Address Line | 7274 DIXIE HWY
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City | BRIDGEPORT
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State | MI
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Zip | 48722-9702
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Country | US
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Telephone | 989-315-8375
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 90674
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City | BURTON
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State | MI
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Zip | 48509-0674
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | TYLER D BREWER
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Credential | LPC
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Telephone | 989-315-8375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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