| Willow Integration LLC | |
|
550 S Montezuma St Ste A Prescott AZ 86303-4200 | |
| (404) 590-2039 | |
| Not Available |
| Full Name | Willow Integration LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 550 S Montezuma St Ste A, Prescott, Arizona |
| Authorized Official Name and Position | Lisa Simone Cleary (OWNER) |
| Authorized Official Contact | 6788868027 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Integration LLC 3050 Windsor Dr Prescott AZ 86301-4862 Ph: (678) 886-8027 | Willow Integration LLC 550 S Montezuma St Ste A Prescott AZ 86303-4200 Ph: (404) 590-2039 |
| NPI Number | 1609703586 |
|---|---|
| Provider Enumeration Date | 05/06/2026 |
| Last Update Date | 05/06/2026 |
| Certification Date | 05/06/2026 |
| Medicare PECOS PAC ID | 1052884889 |
|---|---|
| Medicare Enrollment ID | O20260624000621 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609703586 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | () | Primary |
| Provider Name | Lisa Simone Cleary |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669184966 PECOS PAC ID: 2961975792 Enrollment ID: I20260624000668 |
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