Provider Demographics
NPI:1588404099
Name:WILLOW HAVEN COUNSELING LLC
Entity type:Organization
Organization Name:WILLOW HAVEN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LPC
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NBCC
Authorized Official - Phone:814-232-7112
Mailing Address - Street 1:429 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:JERMYN
Mailing Address - State:PA
Mailing Address - Zip Code:18433-1205
Mailing Address - Country:US
Mailing Address - Phone:814-232-7112
Mailing Address - Fax:
Practice Address - Street 1:1714 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1362
Practice Address - Country:US
Practice Address - Phone:814-232-7112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty