Provider Demographics
NPI:1730971599
Name:WILLOW CREEK COUNSELING LLC
Entity type:Organization
Organization Name:WILLOW CREEK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-269-0004
Mailing Address - Street 1:35 W SAINT ANTHONY LN
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7914
Mailing Address - Country:US
Mailing Address - Phone:314-269-0004
Mailing Address - Fax:
Practice Address - Street 1:8000 BONHOMME AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3985
Practice Address - Country:US
Practice Address - Phone:314-269-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty