| Willow Bay Therapy, Llc | |
|
12805 Highway 55 Ste 216 Plymouth MN 55441-3859 | |
| (612) 440-1450 | |
| (612) 524-5563 |
| Full Name | Willow Bay Therapy, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 12805 Highway 55 Ste 216, Plymouth, Minnesota |
| Authorized Official Name and Position | Joanna Lynn Kelly (OWNER) |
| Authorized Official Contact | 6129611015 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Bay Therapy, Llc 16807 66th Ave N Maple Grove MN 55311-3956 Ph: (612) 961-1015 | Willow Bay Therapy, Llc 12805 Highway 55 Ste 216 Plymouth MN 55441-3859 Ph: (612) 440-1450 |
| NPI Number | 1104354406 |
|---|---|
| Provider Enumeration Date | 05/31/2017 |
| Last Update Date | 10/29/2020 |
| Certification Date | 10/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104354406 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 3192 (Minnesota) | Primary |
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