| Willow Tree Therapy Llc | |
|
1819 11th Str. Great Bend KS 67530-4511 | |
| (620) 603-6257 | |
| (620) 603-6259 |
| Full Name | Willow Tree Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1819 11th Str., Great Bend, Kansas |
| Authorized Official Name and Position | Robin Rayne Abercrombie (OWNER/THERAPIST) |
| Authorized Official Contact | 6206036257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Tree Therapy Llc 1819 11th Str. Great Bend KS 67530-4511 Ph: (620) 603-6257 | Willow Tree Therapy Llc 1819 11th Str. Great Bend KS 67530-4511 Ph: (620) 603-6257 |
| NPI Number | 1063967008 |
|---|---|
| Provider Enumeration Date | 08/19/2016 |
| Last Update Date | 10/27/2020 |
| Certification Date | 10/27/2020 |
| Medicare PECOS PAC ID | 4082980875 |
|---|---|
| Medicare Enrollment ID | O20171023002189 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063967008 | NPI | - | NPPES |
| 200629070A | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 4222 (Kansas) | Primary |
| Provider Name | Robin R Abercrombie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912130626 PECOS PAC ID: 6800039033 Enrollment ID: I20130906000640 |
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