Provider Demographics
NPI:1053914788
Name:WILLOW TREE COUNSELING
Entity type:Organization
Organization Name:WILLOW TREE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAGAT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-696-8426
Mailing Address - Street 1:1612 BONFORTE BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1603
Mailing Address - Country:US
Mailing Address - Phone:719-696-8426
Mailing Address - Fax:719-696-9432
Practice Address - Street 1:1612 BONFORTE BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1603
Practice Address - Country:US
Practice Address - Phone:719-696-8426
Practice Address - Fax:719-696-9432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty