NPIMap

Organization Active NPI

Willowdale Counseling Center, PLLC

  • Clinical Psychologist
  • Nashua, NH
National Provider Identifier
1376635102
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
941 Issued in NH
Legal business name
WILLOWDALE COUNSELING CENTER, PLLC
Practice address
76 Northeastern Blvd Ste 36a
Nashua, NH 03062-3196
Phone
(603) 881-7554
Fax
(603) 881-7533
NPI assigned
Sep 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Authorized official

Name
Timothy C. Bray, PH.D.NPI 1699710509
Title
Owner
Phone
(603) 881-7554

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 941 NH Primary

Addresses

Primary practice location

76 Northeastern Blvd Ste 36a
Nashua, NH 03062-3196

Mailing address

76 Northeastern Blvd Ste 36a
Nashua, NH 03062-3196
Phone (603) 881-7554

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130328000099 NH Part B Supplier - Clinic/Group Practice 4385889112 Receives reassigned benefits from 6 practitioners
Practice locations: Nashua, NH

National Provider Directory

National Provider Directory

Locations

130 Pembroke Rd
Ste 250
Concord, NH 03301
Phone (603) 228-7160

322 Amherst St
Nashua, NH 03063
Phone (603) 881-7554

76 Northeastern Blvd
Ste 36A
Nashua, NH 03062
Phone (603) 881-7554

Practitioners & affiliated clinicians

Practitioners 9

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": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1376635102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 NORTHEASTERN BLVD STE 36A",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "030623196",
            "telephone_number": "603-881-7554",
            "fax_number": "603-881-7533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 NORTHEASTERN BLVD STE 36A",
            "city": "NASHUA",
            "state": "NH",
            "postal_code": "030623196",
            "telephone_number": "603-881-7554",
            "fax_number": "603-881-7533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWDALE COUNSELING CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "BRAY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-881-7554",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NH",
            "license": "941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashua, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; 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.