Provider Demographics
NPI:1215715099
Name:THE WILLOW COUNSELING COLLECTIVE, LLC
Entity type:Organization
Organization Name:THE WILLOW COUNSELING COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-521-7657
Mailing Address - Street 1:601 NIKLES DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2570
Mailing Address - Country:US
Mailing Address - Phone:406-521-7657
Mailing Address - Fax:
Practice Address - Street 1:601 NIKLES DR STE 3
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2570
Practice Address - Country:US
Practice Address - Phone:406-521-7657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty