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General NPI Number Information
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NPI Number | 1851784003
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Entity Type | Organization
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Legal Business Name | WILLOW CREEK COUNSELING ASSOCIATES, LLC
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 2161 COFFEEN AVE STE 401
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City | SHERIDAN
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State | WY
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Zip | 82801-5771
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Country | US
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Telephone | 307-751-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 245 BROADWAY, STE 11 PO BOX 6650
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City | SHERIDAN
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State | WY
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Zip | 82801
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Country | US
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Telephone | 307-751-9090
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | JULI K WALLIN-FISGUS
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Credential | MSW LCSW
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Telephone | 307-751-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW 816
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License Number State | WY
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