Provider Demographics
NPI:1285518019
Name:WILLOW AND SAGE
Entity type:Organization
Organization Name:WILLOW AND SAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ISHAH
Authorized Official - Middle Name:ABI
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-545-0469
Mailing Address - Street 1:11144 S ADRIAN HWY
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:MI
Mailing Address - Zip Code:49248-9744
Mailing Address - Country:US
Mailing Address - Phone:734-545-0469
Mailing Address - Fax:
Practice Address - Street 1:3700 S ADRIAN HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221
Practice Address - Country:US
Practice Address - Phone:734-545-0469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty