# WILLOW TREE MENTAL HEALTH CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Willow Tree Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992254452
- **Authorized official:** KATIE WILSON MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (636) 695-2690

## Contact information

- **Practice address:** 9979 WINGHAVEN BLVD, SUITE 202, O FALLON, MO 63368-3627
- **Practice address phone:** (636) 695-2690
- **Mailing address:** 2123 ROSELAKE CIR, COTTLEVILLE, MO 63376-7772
- **Mailing address phone:** (615) 785-5124

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | — |
| 101YP2500X | Professional Counselor | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | 2011040150 | MO | Yes |

## Other

- **Enumeration date:** 09/26/2016
- **Last updated:** 09/26/2016