Provider Demographics
NPI:1790671063
Name:WILLOW TREE FAMILY COUNSELING
Entity type:Organization
Organization Name:WILLOW TREE FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-200-2332
Mailing Address - Street 1:608 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4105
Mailing Address - Country:US
Mailing Address - Phone:707-200-2332
Mailing Address - Fax:707-200-2332
Practice Address - Street 1:608 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4105
Practice Address - Country:US
Practice Address - Phone:707-200-2332
Practice Address - Fax:707-200-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)