| Willow Creek Counseling Associates, Llc | |
|
2161 Coffeen Ave Ste 401 Sheridan WY 82801-5771 | |
| (307) 751-9090 | |
| Not Available |
| Full Name | Willow Creek Counseling Associates, Llc |
|---|---|
| Speciality | Counselor |
| Location | 2161 Coffeen Ave Ste 401, Sheridan, Wyoming |
| Authorized Official Name and Position | Juli K Wallin-fisgus (CO OWNER) |
| Authorized Official Contact | 3077519090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Creek Counseling Associates, Llc 245 Broadway, Ste 11 Po Box 6650 Sheridan WY 82801 Ph: (307) 751-9090 | Willow Creek Counseling Associates, Llc 2161 Coffeen Ave Ste 401 Sheridan WY 82801-5771 Ph: (307) 751-9090 |
| NPI Number | 1851784003 |
|---|---|
| Provider Enumeration Date | 03/12/2015 |
| Last Update Date | 06/02/2020 |
| Certification Date | 06/02/2020 |
| Medicare PECOS PAC ID | 1254685704 |
|---|---|
| Medicare Enrollment ID | O20181119003170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851784003 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LCSW 816 (Wyoming) | Primary |
| Provider Name | Juli K Wallin-fisgus |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598089807 PECOS PAC ID: 3678708633 Enrollment ID: I20131028001891 |
| Provider Name | Dorrie Dale Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295284180 PECOS PAC ID: 5496017832 Enrollment ID: I20180322001001 |
| Provider Name | Joy Liana Hart Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659615037 PECOS PAC ID: 3072867522 Enrollment ID: I20190125001438 |
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