Provider Demographics
NPI:1124519764
Name:WILLOW CLINICAL SERVICES, LLC
Entity type:Organization
Organization Name:WILLOW CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:REETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:708-955-1388
Mailing Address - Street 1:2150 MANCHESTER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2474
Mailing Address - Country:US
Mailing Address - Phone:708-955-1388
Mailing Address - Fax:630-752-9875
Practice Address - Street 1:2150 MANCHESTER RD STE 110
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2474
Practice Address - Country:US
Practice Address - Phone:630-752-9874
Practice Address - Fax:630-752-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty