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
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
2011040150
MO
Other
Enumeration date
09/26/2016
Last updated
09/26/2016
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