| Willow Tree Center | |
|
9979 Winghaven Blvd Suite 202 O Fallon MO 63368-3627 | |
| (636) 695-2690 | |
| Not Available |
| Full Name | Willow Tree Center |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 9979 Winghaven Blvd, O Fallon, Missouri |
| Authorized Official Name and Position | Katie Wilson (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6366952690 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Tree Center 2123 Roselake Cir Cottleville MO 63376-7772 Ph: (615) 785-5124 | Willow Tree Center 9979 Winghaven Blvd Suite 202 O Fallon MO 63368-3627 Ph: (636) 695-2690 |
| NPI Number | 1992254452 |
|---|---|
| Provider Enumeration Date | 09/26/2016 |
| Last Update Date | 09/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992254452 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 2011040150 (Missouri) | Primary |
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