WILLOW BAY THERAPY, LLC (NPI# 1104354406) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104354406 |
| Entity Type | Organization |
| Organization Name | WILLOW BAY THERAPY, LLC |
| Practice Address |
12805 Highway 55 Ste 216 Plymouth MN 55441-3859 |
| Mailing Address |
16807 66th Ave N Maple Grove MN 55311-3956 |
| Practice Telephone | 6124401450 |
| Practice Fax Number | 6125245563 |
| Mailing Telephone | 6129611015 |
| Mailing Fax Number | 6125245563 |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2020-10-29 |
| Authorized Official Name | MS. JOANNA LYNN KELLY (OWNER) |
| Authorized Official Telephone | 6129611015 |
| Authorized Official Credential | MA, LMFT, RPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
3192 | MN | Ambulatory Health Care Facilities |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 600 Twelve Oaks Center Dr Ste 103, Wayzata, MN 553914530 | 6129611015 | 6125245563 |
| Street Address |
12805 HIGHWAY 55 STE 216 |
| City | PLYMOUTH |
| State | MN |
| Zip Code | 55441-3859 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689190019 | The Recovery Clinic LLC | Clinic/Center | 9800 Shelard Pkwy Ste 215, Plymouth, MN 55441 | 2017-08-17 |
| 1356887186 | Katherine Marlow Bell | Dentist | 2805 Campus Dr Ste 245, Plymouth, MN 55441 | 2017-01-18 |
| 1083069538 | Mercade Waldon | Home Health Aide | 3501 Xenium Lane, Plymouth, MN 55441 | 2016-05-03 |
| 1346645538 | Phs Westhealth, Inc | Skilled Nursing Facility | 2775 Campus Drive North, Plymouth, MN 55441 | 2014-10-30 |
| 1427453125 | Samuel David Fine | Pharmacist | 4070 Goldenrod Ln, Plymouth, MN 55441 | 2014-10-24 |
| 1548672538 | Scott Aaron Schmidt | Dentist | 2720 Annapolis Circle N, Suite A, Plymouth, MN 55441 | 2014-05-23 |
| 1831498633 | Comforide Transportation Services LLC | Non-emergency Medical Transport (VAN) | 9730 37th Pl N Suite 201, Plymouth, MN 55441 | 2011-03-18 |
| 1255669271 | Tammy Kae Mehlhaus | Physician Assistant | 2855 Campus Drive, Suite 570, Plymouth, MN 55441 | 2009-12-02 |
| 1164758199 | Stephen P. Boger, Dds, Pa | Dentist | 2720 Annapolis Circle, Suite A, Plymouth, MN 55441 | 2009-10-27 |
| 1093908360 | Endodontic Professionals Pa Plymouth Endodontics | Dentist | 3401 Hwy 169 N, Plymouth, MN 55441 | 2007-08-21 |
| Find all providers in zip 55441 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154984623 | Monarch Behavioral Health Pllc | Clinic/Center | 9800 Shelard Pkwy Ste 115, Plymouth, MN 55441-6411 | 2019-04-19 |
| 1487145546 | African American Child Wellness Institute | Clinic/Center | 9800 Shelard Pkwy Ste 325, Plymouth, MN 55441-6453 | 2018-05-24 |
| 1063923043 | Jtcounselingservices | Clinic/Center | 5060 Holly Ln N Unit 4, Plymouth, MN 55446-1763 | 2017-10-18 |
| 1689190019 | The Recovery Clinic LLC | Clinic/Center | 9800 Shelard Pkwy Ste 215, Plymouth, MN 55441 | 2017-08-17 |
| 1124687660 | Mjm Counseling Pllc | Clinic/Center | 340 N Main St, Plymouth, MI 48170-1249 | 2019-06-09 |
| 1750852570 | Tyler Pollack Incorporated | Clinic/Center | 595 Forest Ave, Plymouth, MI 48170-1775 | 2018-12-06 |
| 1265911945 | Anne Krcatovich, Ma, LLP, LLC | Clinic/Center | 164 N Main St, Plymouth, MI 48170-1236 | 2018-08-13 |
| 1679070635 | Sw Counseling Services LLC | Clinic/Center | 340 N Main St Ste 201, Plymouth, MI 48170-1290 | 2018-04-06 |
| 1316306418 | Nicole Reynolds Psyd LLC | Clinic/Center | 158 N Main St, Plymouth, MI 48170-1236 | 2016-02-17 |
| 1922434653 | Orl Limited LLC | Clinic/Center | 30 Aldrin Rd, Plymouth, MA 02360-4804 | 2013-09-26 |
| Find all providers in PLYMOUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.