Organization
WILLOW MENTAL WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COREY LARISCY (OWNER)
(313) 418-0273
Entity
Organization
Contact information
Practice address
513 DETROIT AVE, ROYAL OAK, MI 48073-3692
(313) 418-0273
Mailing address
513 DETROIT AVE, ROYAL OAK, MI 48073-3692
(313) 418-0273
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/02/2023
Last updated
10/02/2023
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