Provider Demographics
NPI:1538400312
Name:WILLOW TREE BEHAVIORAL HEALTH AND COUNCSELING
Entity type:Organization
Organization Name:WILLOW TREE BEHAVIORAL HEALTH AND COUNCSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:856-366-0642
Mailing Address - Street 1:244 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2604
Mailing Address - Country:US
Mailing Address - Phone:856-366-0642
Mailing Address - Fax:
Practice Address - Street 1:244 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-2604
Practice Address - Country:US
Practice Address - Phone:856-366-0642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00392500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty