Provider Demographics
NPI:1902356843
Name:WILLOUGHBY COUNSELING LLC
Entity Type:Organization
Organization Name:WILLOUGHBY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, PCP NCC
Authorized Official - Phone:913-484-4820
Mailing Address - Street 1:2106 S 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2104
Mailing Address - Country:US
Mailing Address - Phone:913-484-4820
Mailing Address - Fax:402-934-2101
Practice Address - Street 1:2106 S 87 AVENUE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2104
Practice Address - Country:US
Practice Address - Phone:913-484-4820
Practice Address - Fax:402-934-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1353101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty