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General NPI Number Information
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NPI Number | 1710584883
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Entity Type | Organization
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Legal Business Name | WILLOW BEND COUNSELING LLC
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 351 MANVILLE RD STE 104
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-2166
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Country | US
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Telephone | 914-825-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 1727 MAPLE AVE
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City | PEEKSKILL
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State | NY
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Zip | 10566-4837
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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 | MEMBER/OWNER
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Name | NICOLE GOUDREAU-GREEN
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Credential | LCSW-R
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Telephone | 914-825-4800
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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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