Willow Sage Services LLC

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

WILLOW SAGE SERVICES LLC

Practice address

211 S Woodruff Ave Ste A3
Idaho Falls, ID 83401-4865

Phone

(208) 524-4818

Fax

(208) 522-6630

NPI assigned

Oct 25, 2016

Last updated

May 9, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Tresia Jones

Title

Owner

Phone

(208) 233-1276

Specialties & licenses 8

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shasta Lee Hardee, LMSW-37764

  • Social Worker
  • Idaho Falls, ID
  • NPI 1194992545
  Medicare reassignment Care Compare group NPD
• Traci Alene Kettle

  • Marriage & Family Therapist
  • Idaho Falls, ID
  • NPI 1679622971
  Medicare reassignment Care Compare group NPD
• John Patrick O'Neal, LCPC

  • Professional Counselor
  • Idaho Falls, ID
  • NPI 1710318480
  Medicare reassignment Care Compare group NPD
• Brent Angel Ellsworth, PA-C

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1831412063
  Medicare reassignment Care Compare group
• John P Condron, M.S., L.C.P.C.

  • Mental Health Counselor
  • Pocatello, ID
  • NPI 1972710564
  Medicare reassignment NPD
• Shelby Dawn Beckstead, LMSW

  • Social Worker
  • Idaho Falls, ID
  • NPI 1538044953
  NPD
• Kelsey Lynn Cole, LPC

  • Mental Health Counselor
  • Idaho Falls, ID
  • NPI 1003473455
  NPD
• Brenna Jones, LMSW

  • Clinical Social Worker
  • Idaho Falls, ID
  • NPI 1134906621
  NPD
• Steven Richard Miner, MS, MFT, LPC

  • Professional Counselor
  • Pocatello, ID
  • NPI 1508396714
  NPD
• Angelika Katerina Van Grinsven, LPCC

  • Professional Counselor
  • Albuquerque, NM
  • NPI 1609410489
  NPD
• Todd Devries, MSW

  • Social Worker
  • Idaho Falls, ID
  • NPI 1881183499
  NPD (past)
• Roberta Gustafson, LMSW

  • Social Worker
  • Pocatello, ID
  • NPI 1427413798
  NPD (past)

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

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652054400000",
    "number": "1538611652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 S WOODRUFF AVE STE A3",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014865",
            "telephone_number": "208-233-1276",
            "fax_number": "208-233-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S WOODRUFF AVE STE A3",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834014865",
            "telephone_number": "208-524-4818",
            "fax_number": "208-522-6630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "440 E Clark St Ste A",
            "address_purpose": "LOCATION",
            "city": "Pocatello",
            "state": "ID",
            "postal_code": "832016308",
            "country_code": "US",
            "telephone_number": "208-233-1276",
            "fax_number": "208-233-0835",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "440 E Clark St Ste A",
            "address_purpose": "LOCATION",
            "city": "Pocatello",
            "state": "ID",
            "postal_code": "832016308",
            "country_code": "US",
            "telephone_number": "208-233-1276",
            "fax_number": "208-233-0835",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILLOW SAGE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-25",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TRESIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-233-1276",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katelyn Rose Willis
• Robert Willis, PA-C
• Roderick Jack Willmore, M.D.
• Willow Creek Dental
• Willow Creek Dental PC
• Bridgette Wilson, PHARMD
• David Earl Wilson, D.D.S
• Emily Wilson
• Millie Wilson
• Nichole Chauntelle Wilson

• Counselor in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; 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.