Provider Demographics
NPI:1285330936
Name:WILLOW BAY COUNSELING LLC
Entity type:Organization
Organization Name:WILLOW BAY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BREINER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-784-6460
Mailing Address - Street 1:103 W TOMICHI AVE STE 201-C
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2323
Mailing Address - Country:US
Mailing Address - Phone:970-784-6460
Mailing Address - Fax:
Practice Address - Street 1:103 W TOMICHI AVE STE 201-C
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2323
Practice Address - Country:US
Practice Address - Phone:970-784-6460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty