| Willowdale Counseling Center, Pllc | |
|
76 Northeastern Blvd Ste 36a Nashua NH 03062-3196 | |
| (603) 881-7554 | |
| (603) 881-7533 |
| Full Name | Willowdale Counseling Center, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 76 Northeastern Blvd Ste 36a, Nashua, New Hampshire |
| Authorized Official Name and Position | Timothy C. Bray (OWNER) |
| Authorized Official Contact | 6038817554 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willowdale Counseling Center, Pllc 76 Northeastern Blvd Ste 36a Nashua NH 03062-3196 Ph: (603) 881-7554 | Willowdale Counseling Center, Pllc 76 Northeastern Blvd Ste 36a Nashua NH 03062-3196 Ph: (603) 881-7554 |
| NPI Number | 1376635102 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 09/01/2021 |
| Certification Date | 09/01/2021 |
| Medicare PECOS PAC ID | 4385889112 |
|---|---|
| Medicare Enrollment ID | O20130328000099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376635102 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 941 (New Hampshire) | Primary |
| Provider Name | Timothy C Bray |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699710509 PECOS PAC ID: 1658344841 Enrollment ID: I20040816001339 |
| Provider Name | Karen B Foulke |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1821286949 PECOS PAC ID: 4183536824 Enrollment ID: I20110706000198 |
| Provider Name | Cynthia S Ludwick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376892737 PECOS PAC ID: 5799936191 Enrollment ID: I20121113000054 |
| Provider Name | Suzanne Courter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417721705 PECOS PAC ID: 1557711363 Enrollment ID: I20231220000400 |
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