Healthcare Provider Details

I. General information

NPI: 1801708839
Provider Name (Legal Business Name): WILDFLOWER TRAUMA AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 KING ST
BRISTOL CT
06010-5234
US

IV. Provider business mailing address

63 ENO AVE
TORRINGTON CT
06790-5622
US

V. Phone/Fax

Practice location:
  • Phone: 860-795-6695
  • Fax:
Mailing address:
  • Phone: 860-795-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MORGAN EVANS
Title or Position: CEO/FOUNDER
Credential:
Phone: 860-795-6695