Provider Demographics
NPI:1952157950
Name:WILLOW WELCH COUNSELING CLINIC LLC
Entity type:Organization
Organization Name:WILLOW WELCH COUNSELING CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLOW
Authorized Official - Middle Name:EVE
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-917-7290
Mailing Address - Street 1:263 THUNDERBIRD LOOP
Mailing Address - Street 2:
Mailing Address - City:TRASKWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72167-9051
Mailing Address - Country:US
Mailing Address - Phone:870-917-7290
Mailing Address - Fax:
Practice Address - Street 1:302 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-3737
Practice Address - Country:US
Practice Address - Phone:501-229-1515
Practice Address - Fax:888-337-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty