| Organization Name: | WILLOW BEND CENTER |
| NPI Number: | 1023300720 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES PRESTON FLORENCE (EXECUTIVE DIRECTOR) |
| Mailing Address: | 2902 State Highway 31 E Tyler |
| State: | TX US |
| Postal Code: | 757028613 |
| Phone Number: | 9035968900 |
| Fax Number: | 9035968903 |
| NPI Enumeration Date: | 05/12/2011 |
| NPI Last Update Date: | 05/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 65784 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |