Willow Tree Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10138 Issued in SC

Legal business name

WILLOW TREE COUNSELING LLC

Practice address

107 E Park Ave
Greenville, SC 29601-1631

Phone

(864) 729-4184

Fax

(864) 729-4044

NPI assigned

Oct 27, 2016

Organization subpart

No

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

Authorized official

Name

Michele Ann Balderson, LISW-CP

Title

Psychotherapist Coowner

Phone

(864) 436-9075

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477526400000",
    "number": "1841742632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E PARK AVE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296011631",
            "telephone_number": "864-729-4184",
            "fax_number": "864-729-4044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E PARK AVE",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296011631",
            "telephone_number": "864-729-4184",
            "fax_number": "864-729-4044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW TREE COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-27",
        "last_updated": "2016-10-27",
        "status": "A",
        "authorized_official_last_name": "BALDERSON",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST COOWNER",
        "authorized_official_telephone_number": "864-436-9075",
        "authorized_official_credential": "LISW-CP"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "10138",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "10511",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SW1324",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SW1327",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristen Britt Willis, RN
• Lynne J Willis, M.A., CCC-SLP
• Randi Meghan Willis, LMSW
• Terry A Willis, D.M.D.
• Willoughby Dental PA (Willoughby Dental)
• Melanie H. Wills, M.D.
• Nolah Wills, RBT
• Amanda Wilson, HAIR LOSS SPECIALIST
• Amy Marie Wilson, DNP
• Audrey Elizabeth Wilson

• Clinical Social Worker in Greenville, SC
• Providers in Greenville, SC by specialty
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; 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.