Provider Demographics
NPI:1124765383
Name:WILLOW PATHWAYS THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:WILLOW PATHWAYS THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPCC
Authorized Official - Phone:507-225-0450
Mailing Address - Street 1:881 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6139
Mailing Address - Country:US
Mailing Address - Phone:507-225-0450
Mailing Address - Fax:507-779-7182
Practice Address - Street 1:881 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6139
Practice Address - Country:US
Practice Address - Phone:507-225-0450
Practice Address - Fax:507-779-7182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1124765383Medicaid