| Willowstone Family Services | |
|
615 N. 18th St. Suite 101 Lafayette IN 47904-3434 | |
| (765) 423-5361 | |
| (765) 742-8272 |
| Full Name | Willowstone Family Services |
|---|---|
| Speciality | Counselor |
| Location | 615 N. 18th St., Lafayette, Indiana |
| Authorized Official Name and Position | Rebecca Sullivan (CEO) |
| Authorized Official Contact | 7654235361 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willowstone Family Services 615 N. 18th St. Suite 101 Lafayette IN 47904-3434 Ph: (765) 423-5361 | Willowstone Family Services 615 N. 18th St. Suite 101 Lafayette IN 47904-3434 Ph: (765) 423-5361 |
| NPI Number | 1780742874 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 05/03/2024 |
| Certification Date | 05/03/2024 |
| Medicare PECOS PAC ID | 0749234904 |
|---|---|
| Medicare Enrollment ID | O20070716000142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780742874 | NPI | - | NPPES |
| 100264050 | Medicaid | IN | |
| 100445220A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Janelle W Ohlemiller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740766740 PECOS PAC ID: 7719234723 Enrollment ID: I20180723001877 |
| Provider Name | Jamie Petersen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295271294 PECOS PAC ID: 1254758055 Enrollment ID: I20200825001725 |
| Provider Name | Natalia Benesko-milner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225110976 PECOS PAC ID: 0042622433 Enrollment ID: I20240205000818 |
| Provider Name | Lisa Marie Lucy |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1790802304 PECOS PAC ID: 9537512132 Enrollment ID: I20240205002434 |
| Provider Name | Zachary Ray Doscher |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184110603 PECOS PAC ID: 1052754215 Enrollment ID: I20240205004084 |
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