| Willow Creek Wellness Llc | |
|
3630 Sinton Rd Ste 320 Colorado Springs CO 80907-5070 | |
| (877) 881-4551 | |
| (719) 960-2405 |
| Full Name | Willow Creek Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 3630 Sinton Rd Ste 320, Colorado Springs, Colorado |
| Authorized Official Name and Position | Owen Eustice (OWNER) |
| Authorized Official Contact | 3033857920 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Creek Wellness Llc 3630 Sinton Rd Ste 320 Colorado Springs CO 80907-5070 Ph: (877) 881-4551 | Willow Creek Wellness Llc 3630 Sinton Rd Ste 320 Colorado Springs CO 80907-5070 Ph: (877) 881-4551 |
| NPI Number | 1710466529 |
|---|---|
| Provider Enumeration Date | 08/13/2018 |
| Last Update Date | 03/23/2022 |
| Certification Date | 03/23/2022 |
| Medicare PECOS PAC ID | 2567885742 |
|---|---|
| Medicare Enrollment ID | O20200707000429 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710466529 | NPI | - | NPPES |
| 9000173251 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 09924585 (Colorado) | Primary |
| Provider Name | La Tasha M Bruner-hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386161032 PECOS PAC ID: 7517233471 Enrollment ID: I20171019002168 |
| Provider Name | Katie Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093797060 PECOS PAC ID: 4688754369 Enrollment ID: I20200707000407 |
| Provider Name | Linda Murt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326683079 PECOS PAC ID: 4183012479 Enrollment ID: I20211019000496 |
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