WILLOW BAY THERAPY LLC NPI 1104354406

NPI Information

  • NPI: 1104354406
  • Provider Name: WILLOW BAY THERAPY, LLC
  • Classification: Clinic/Center - 261QM0801X
  • Specialization: Mental Health (Including Community Mental Health Center)
  • Entity Type: Organization
  • Address: 12805 HIGHWAY 55 STE 216
    PLYMOUTH, MN
    ZIP 55441
  • Phone: (612) 440-1450

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NPI Details

WILLOW BAY THERAPY, LLC is a mental health (including community mental health center) clinic center in Plymouth, MN. WILLOW BAY THERAPY, LLC NPI is 1104354406. The provider is registered as an organization entity type.

The provider's business location address is:

12805 HIGHWAY 55 STE 216
PLYMOUTH, MN
ZIP 55441-859
Phone: (612) 440-1450
Fax: (612) 524-5563

The provider's authorized official is Joanna Lynn Kelly .
The authorized official title is Owner and has the following contact phone number (612) 961-1015.

The enumeration date for this NPI number is 5/31/2017 and was last updated on 10/29/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)3192MINNESOTAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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