Willow Tree Mental Health Center, LLC

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

2011040150 Issued in MO

Legal business name

WILLOW TREE MENTAL HEALTH CENTER, LLC

Doing business as

Willow Tree Center

Practice address

9979 Winghaven Blvd
Suite 202
O Fallon, MO 63368-3627

Phone

(636) 695-2690

NPI assigned

Sep 26, 2016

Organization subpart

No

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

Authorized official

Name

Katie Wilson, MD

Title

Medical Director

Phone

(636) 695-2690

Specialties & licenses 2

Addresses

Other names 1

• Willow Tree Center Doing business as

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

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474848000000",
    "number": "1992254452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2123 ROSELAKE CIR",
            "city": "COTTLEVILLE",
            "state": "MO",
            "postal_code": "633767772",
            "telephone_number": "615-785-5124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9979 WINGHAVEN BLVD",
            "address_2": "SUITE 202",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683627",
            "telephone_number": "636-695-2690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW TREE MENTAL HEALTH CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-26",
        "last_updated": "2016-09-26",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "636-695-2690",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MO",
            "license": "2011040150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Tree Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael A Williams, DC
• Michael L Williams, D.O.
• Rachel Williams I, DPT
• Scott G Williams, M.D.
• Heather Carolyn Williamson, DO
• Christine C Wilson, LMT NCTMB
• Jennifer Leah Wilson
• Jennifer Susan Wilson, SLP
• Kalissa Lynn Wilson, MS CCC-SLP
• Katelynn Wilson

• Child & Adolescent Psychiatry Physician in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• Child & Adolescent Psychiatry Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.