| Willow Tree Counseling | |
|
1612 Bonforte Blvd Pueblo CO 81001-1603 | |
| (719) 696-8426 | |
| (719) 696-9432 |
| Full Name | Willow Tree Counseling |
|---|---|
| Speciality | Social Worker |
| Location | 1612 Bonforte Blvd, Pueblo, Colorado |
| Authorized Official Name and Position | Kimberlee Balagat (OWNER) |
| Authorized Official Contact | 7196968426 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Tree Counseling 1612 Bonforte Blvd Pueblo CO 81001-1603 Ph: (719) 696-8426 | Willow Tree Counseling 1612 Bonforte Blvd Pueblo CO 81001-1603 Ph: (719) 696-8426 |
| NPI Number | 1053914788 |
|---|---|
| Provider Enumeration Date | 11/17/2020 |
| Last Update Date | 04/20/2023 |
| Certification Date | 04/20/2023 |
| Medicare PECOS PAC ID | 3678923539 |
|---|---|
| Medicare Enrollment ID | O20231219002231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053914788 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (NU) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (NU) | Secondary |
| Provider Name | Kimberlee J Balagat |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154802577 PECOS PAC ID: 3274885256 Enrollment ID: I20181003001693 |
| Provider Name | Anisha Perez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679350540 PECOS PAC ID: 2264871482 Enrollment ID: I20240419001654 |
| Provider Name | Niesha Marie Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629949433 PECOS PAC ID: 9537637541 Enrollment ID: I20260507004160 |
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