Willow Creek Wellness LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

09924585 Issued in CO

Legal business name

WILLOW CREEK WELLNESS LLC

Practice address

3630 Sinton Rd Ste 320
Colorado Springs, CO 80907-5070

Phone

(877) 881-4551

Fax

(719) 960-2405

NPI assigned

Aug 13, 2018

Organization subpart

No

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

Authorized official

Name

Owen Eustice, LCSW

Title

Owner

Phone

(303) 385-7920

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

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

• Victoria Williams, MS, LPCC

  • Professional Counselor
  • Colorado Springs, CO
  • NPI 1710505896

  Clinical

  NPD
• Jaime D'Eredita, LCSW

  • Clinical Social Worker
  • Colorado Springs, CO
  • NPI 1437710902
  NPD (past)

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1710466529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 SINTON RD STE 320",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809075070",
            "telephone_number": "877-881-4551",
            "fax_number": "719-960-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 SINTON RD STE 320",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809075070",
            "telephone_number": "877-881-4551",
            "fax_number": "719-960-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-13",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "EUSTICE",
        "authorized_official_first_name": "OWEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-385-7920",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "09924585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000173251",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Schuyler Elizabeth Willis, MA, LPC
• Diane Cheryl Williston, DPT
• Eric Williston, DPT
• Bertram Willman, MD
• Willow and Courage Counseling, LLC
• Willow Crest, Inc.
• Willow Crest, Inc.
• Willows Counseling LLC
• Willows Counseling LLC
• Jenna Willsey

• Clinical Social Worker in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Clinical Social Worker in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; 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.