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General NPI Number Information
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NPI Number | 1750848784
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Entity Type | Organization
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Legal Business Name | WILLOW TREE COUNSELING, LLC
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Dates
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Enumeration Date | 02/26/2019
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Last Update Date | 06/26/2021
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Provider Practice Location Address
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Address Line | 15 W LA RUA ST
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City | PENSACOLA
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State | FL
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Zip | 32501-3933
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Country | US
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Telephone | 850-206-4845
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Fax | 850-665-3288
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Provider Business Mailing Address
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Address Line | 3620 GOYA CT
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City | PENSACOLA
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State | FL
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Zip | 32504-4522
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Country | US
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Telephone | 850-206-4845
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Fax | 850-438-4649
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. DONNA WATSON
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Credential | LCSW
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Telephone | 850-206-4845
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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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Taxonomy #2
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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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