MEDICARE: WILLOW ROOTS THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1013858174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW ROOTS THERAPY

Provider Business Mailing Address
First Line	:	4250 33RD AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-1366
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2208 NW MARKET ST STE 411
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4097
Country	:	US
Telephone Number	:	858-405-3874
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHANG LU
Credential	:	LMHC
Telephone Number	:	858-405-3874

Provider Enumeration Date	:	04/02/2026
Last Update Date	:	04/02/2026

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Directions to “WILLOW ROOTS THERAPY ” Practice Location

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