NPIMap

Organization Active NPI

Willow Tree Counseling

  • Clinical Social Worker
  • Pueblo, CO
National Provider Identifier
1053914788
Registry record updated Apr 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
WILLOW TREE COUNSELING
Practice address
1612 Bonforte Blvd
Pueblo, CO 81001-1603
Phone
(719) 696-8426
Fax
(719) 696-9432
NPI assigned
Nov 17, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2023

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

Authorized official

Name
Kimberlee Balagat, LCSWNPI 1154802577
Title
Owner
Phone
(719) 696-8426

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

1612 Bonforte Blvd
Pueblo, CO 81001-1603

Mailing address

1612 Bonforte Blvd
Pueblo, CO 81001-1603
Phone (719) 696-8426

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231219002231 CO Part B Supplier - Clinic/Group Practice 3678923539 Receives reassigned benefits from 3 practitioners
Practice locations: Pueblo, CO

National Provider Directory

National Provider Directory
Tax ID family
Willow Tree Counseling3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1605571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681948800000",
    "number": "1053914788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1612 BONFORTE BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011603",
            "telephone_number": "719-696-8426",
            "fax_number": "719-696-9432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1612 BONFORTE BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810011603",
            "telephone_number": "719-696-8426",
            "fax_number": "719-696-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW TREE COUNSELING",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-17",
        "last_updated": "2023-04-20",
        "certification_date": "2023-04-20",
        "status": "A",
        "authorized_official_last_name": "BALAGAT",
        "authorized_official_first_name": "KIMBERLEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-696-8426",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.