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Organization
WILLOW THERAPY PLLC
Active
Organization
WILLOW THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDICE KAYE BERGER LPC (OWNER)
(719) 201-8714
Entity
Organization
Contact information
Practice address
509 SCOTT AVE STE 2B, WOODLAND PARK, CO 80863-1294
(719) 201-8714
Mailing address
PO BOX 116, DIVIDE, CO 80814-0116
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPC.0014523
DORA
CO
Enumeration date
06/19/2020
Last updated
06/19/2020
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