Willow Bend Center

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

65784 Issued in TX

Legal business name

WILLOW BEND CENTER

Practice address

2902 State Highway 31 E
Tyler, TX 75702-8613

Phone

(903) 596-8900

Fax

(903) 596-8903

NPI assigned

May 12, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. James Preston Florence, PH.D

Title

Executive Director

Phone

(903) 596-8900

Specialties & licenses 1

Addresses

Tax ID family

Willow Bend Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Willow Bend Center

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Longview, TX
  • NPI 1851458087
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305158400000",
    "number": "1023300720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2902 STATE HIGHWAY 31 E",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028613",
            "telephone_number": "903-596-8900",
            "fax_number": "903-596-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2902 STATE HIGHWAY 31 E",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028613",
            "telephone_number": "903-596-8900",
            "fax_number": "903-596-8903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW BEND CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-12",
        "last_updated": "2011-05-12",
        "status": "A",
        "authorized_official_last_name": "FLORENCE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "PRESTON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "903-596-8900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "65784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kentoya Venga Willis
• Sherilyn A. Willis, M.D.
• Tammye Willis, APRN, FNP-C
• Tyler Willis, M.D.
• Anna Beth Willits
• Willow Counseling Center
• Willow Wellness Center, P.a.
• James M Willtrout
• Wilson Chiropractic and Acupuncture PLLC
• Wilson Renfroe, PSYD, PLLC

• Professional Counselor in Tyler, TX
• Providers in Tyler, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.