Healthcare Provider Details

I. General information

NPI: 1760393987
Provider Name (Legal Business Name): WILDFLOWER YOUTH AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 FOREST AVE STE 3B
PLYMOUTH MI
48170-1780
US

IV. Provider business mailing address

580 FOREST AVE STE 3B
PLYMOUTH MI
48170-1780
US

V. Phone/Fax

Practice location:
  • Phone: 734-747-3602
  • Fax:
Mailing address:
  • Phone: 734-747-3602
  • 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: LILLY MARTINEZ
Title or Position: BOARD PRESIDENT
Credential: LMSW
Phone: 734-747-3602