Willow Tree Healing Center, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

13119 Issued in MN

Legal business name

WILLOW TREE HEALING CENTER, LLC

Practice address

1821 University Ave W
Suite S329
Saint Paul, MN 55104-2801

Phone

(651) 222-9885

Fax

(888) 977-2056

NPI assigned

Mar 31, 2009

Organization subpart

No

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

Authorized official

Name

Tracey Wilkins, LICSW

Title

Clinical Services Director

Phone

(651) 222-9985

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Tracey Wilkins, LICSW, LLC Former legal business name

Locations

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

{
    "created_epoch": "1238457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424304000000",
    "number": "1912149345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 UNIVERSITY AVE",
            "address_2": "SUITE S329",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55104",
            "telephone_number": "651-222-9885",
            "fax_number": "888-977-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 UNIVERSITY AVE W",
            "address_2": "SUITE S329",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551042801",
            "telephone_number": "651-222-9885",
            "fax_number": "888-977-2056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW TREE HEALING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-31",
        "last_updated": "2015-02-19",
        "status": "A",
        "authorized_official_last_name": "WILKINS",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "CLINICAL SERVICES DIRECTOR",
        "authorized_official_telephone_number": "651-222-9985",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "13119",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "15043",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "312174700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tracey Wilkins, LICSW, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jared Thomas Williamson, CRNA
• Matthew Williamson
• Charlotte Willis
• Nora Willkomm, DDS
• Willow Tree Clinic
• Willow Wellness Inc
• Willows of Episcopal Homes LLC
• Laura Elizabeth Willson, PA-C
• Michael L Willson, MD
• Devolia Wilson-Johnson

• Clinical Social Worker in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 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.