Healthcare Provider Details

I. General information

NPI: 1700791886
Provider Name (Legal Business Name): WILDFLOWER COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W SUN STREET
MOREHEAD KY
40351
US

IV. Provider business mailing address

PO BOX 71
MOREHEAD KY
40351-0071
US

V. Phone/Fax

Practice location:
  • Phone: 606-548-1443
  • Fax: 606-548-1443
Mailing address:
  • Phone: 606-548-1443
  • Fax: 606-548-1443

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: TERESA M TACKETT
Title or Position: OWNER
Credential:
Phone: 606-548-1443