Willow Tree Life Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

34005160A Issued in IN

Legal business name

WILLOW TREE LIFE COUNSELING LLC

Practice address

10830 Meadow Lake Dr
Indianapolis, IN 46229-3500

Phone

(317) 902-6724

NPI assigned

Mar 17, 2015

Organization subpart

No

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

Authorized official

Name

Gerardine Maria Waggle, MSW, LCSW

Title

Mental Health Therapist

Phone

(317) 902-6724

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1426550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426550400000",
    "number": "1518350370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5660 CAITO DR STE 122",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462261364",
            "telephone_number": "317-902-6724",
            "fax_number": "317-377-3103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10830 MEADOW LAKE DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462293500",
            "telephone_number": "317-902-6724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW TREE LIFE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-17",
        "last_updated": "2015-03-17",
        "status": "A",
        "authorized_official_last_name": "WAGGLE",
        "authorized_official_first_name": "GERARDINE",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "MENTAL HEALTH THERAPIST",
        "authorized_official_telephone_number": "317-902-6724",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34005160A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2015; 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.