Provider Demographics
NPI:1902426695
Name:WILLOW TREE BEHAVIOR ANALYSIS CONSULTING
Entity Type:Organization
Organization Name:WILLOW TREE BEHAVIOR ANALYSIS CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-842-1536
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:HANNAWA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13647-0005
Mailing Address - Country:US
Mailing Address - Phone:315-842-1536
Mailing Address - Fax:
Practice Address - Street 1:90 RIGGS DRIVE
Practice Address - Street 2:4
Practice Address - City:HANNAWA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13647
Practice Address - Country:US
Practice Address - Phone:315-514-0059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty