Provider Demographics
NPI:1306233077
Name:WILLOW TREE LLC
Entity type:Organization
Organization Name:WILLOW TREE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:316-779-2560
Mailing Address - Street 1:7348 W 21ST ST N
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1793
Mailing Address - Country:US
Mailing Address - Phone:316-779-2560
Mailing Address - Fax:316-854-2303
Practice Address - Street 1:7348 W 21ST ST N
Practice Address - Street 2:SUITE 107
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1793
Practice Address - Country:US
Practice Address - Phone:316-779-2560
Practice Address - Fax:316-854-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty