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General NPI Number Information
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NPI Number | 1790226371
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Entity Type | Organization
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Legal Business Name | WILLOW TREE PSYCHOTHERAPY
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 1525 E 53RD ST SUITE 405
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City | CHICAGO
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State | IL
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Zip | 60615-4557
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Country | US
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Telephone | 708-277-9112
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Fax |
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Provider Business Mailing Address
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Address Line | 12110 ANN ST ANN ST
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City | BLUE ISLAND
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State | IL
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Zip | 60406
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Country | US
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Telephone | 305-747-2932
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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 | SARAH MANAHER
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Credential | LCSW
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Telephone | 305-747-2932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149013890
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License Number State | IL
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