| Willow Path Counseling Services | |
|
5725 Venture Park Dr Ste B Kalamazoo MI 49009-2816 | |
| (269) 355-0725 | |
| Not Available |
| Full Name | Willow Path Counseling Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5725 Venture Park Dr Ste B, Kalamazoo, Michigan |
| Authorized Official Name and Position | Stacey Fox (OWNER) |
| Authorized Official Contact | 2693550725 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Path Counseling Services 23939 Finch Ave Mattawan MI 49071-8032 Ph: (269) 355-0725 | Willow Path Counseling Services 5725 Venture Park Dr Ste B Kalamazoo MI 49009-2816 Ph: (269) 355-0725 |
| NPI Number | 1568997054 |
|---|---|
| Provider Enumeration Date | 04/22/2017 |
| Last Update Date | 05/02/2024 |
| Certification Date | 05/02/2024 |
| Medicare PECOS PAC ID | 2163791146 |
|---|---|
| Medicare Enrollment ID | O20170706002915 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568997054 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 6801091193 (Michigan) | Primary |
| Provider Name | Debra A Broughman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831226216 PECOS PAC ID: 3678626124 Enrollment ID: I20090730000249 |
| Provider Name | Robert Swiatek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841526530 PECOS PAC ID: 9739210592 Enrollment ID: I20100623000750 |
| Provider Name | Stacey S Fox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952674699 PECOS PAC ID: 9537392006 Enrollment ID: I20140507002127 |
| Provider Name | Molly Ballantyne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841814779 PECOS PAC ID: 1951778836 Enrollment ID: I20221107000335 |
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