Provider Demographics
NPI:1538584438
Name:THE WILLOW TREE CENTER FOR COUNSELING, PSYCHOTHERAPY, AND CLINICAL HYP
Entity type:Organization
Organization Name:THE WILLOW TREE CENTER FOR COUNSELING, PSYCHOTHERAPY, AND CLINICAL HYP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:NC
Authorized Official - Last Name:MORFELD
Authorized Official - Suffix:
Authorized Official - Credentials:LISW, LCSW, PSYD
Authorized Official - Phone:505-301-3678
Mailing Address - Street 1:5505 SUMMER RIDGE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3434
Mailing Address - Country:US
Mailing Address - Phone:505-301-3678
Mailing Address - Fax:505-792-2277
Practice Address - Street 1:3200 CARLISLE BLVD NE
Practice Address - Street 2:SUITE 131
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1600
Practice Address - Country:US
Practice Address - Phone:505-301-3678
Practice Address - Fax:505-792-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-06664251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO40024229Medicaid
NM25200704Medicaid