Provider Demographics
NPI:1194304097
Name:WILLOW ROOTS, LTD.
Entity type:Organization
Organization Name:WILLOW ROOTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ERICA
Authorized Official - Last Name:LAPOINTE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:970-689-4620
Mailing Address - Street 1:2901 ELEVADO CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-7900
Mailing Address - Country:US
Mailing Address - Phone:970-689-4620
Mailing Address - Fax:
Practice Address - Street 1:3320 W EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-9176
Practice Address - Country:US
Practice Address - Phone:970-689-4620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)