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Organization
WILLOW TREE MENTAL HEALTH CENTER, LLC
Active
Organization
WILLOW TREE MENTAL HEALTH CENTER, LLC
Active
Other names
Willow Tree Center
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE WILSON MD (MEDICAL DIRECTOR)
(636) 695-2690
Entity
Organization
Contact information
Practice address
9979 WINGHAVEN BLVD, SUITE 202, O FALLON, MO 63368-3627
(636) 695-2690
Mailing address
2123 ROSELAKE CIR, COTTLEVILLE, MO 63376-7772
(615) 785-5124
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
2011040150
MO
Other
Enumeration date
09/26/2016
Last updated
09/26/2016
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