Provider Demographics
NPI:1447445648
Name:THE WILLOWS TREATMENT CENTER LLC
Entity type:Organization
Organization Name:THE WILLOWS TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MAYDA
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLLEROS
Authorized Official - Suffix:
Authorized Official - Credentials:M ED LPC
Authorized Official - Phone:956-541-8040
Mailing Address - Street 1:905 E. LOS EBANOS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8720
Mailing Address - Country:US
Mailing Address - Phone:956-541-8040
Mailing Address - Fax:956-205-0430
Practice Address - Street 1:905 E LOS EBANOS BLVD
Practice Address - Street 2:STE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8706
Practice Address - Country:US
Practice Address - Phone:956-541-8040
Practice Address - Fax:956-205-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035DLOtherBC/BS
TX116832OtherSUPERIOR HEALTH PLAN