Healthcare Provider Details

I. General information

NPI: 1275476293
Provider Name (Legal Business Name): WILDFLOWER COUNSELING COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 SE 191ST PL
GRESHAM OR
97030-5119
US

IV. Provider business mailing address

2525 SE 191ST PL
GRESHAM OR
97030-5119
US

V. Phone/Fax

Practice location:
  • Phone: 505-999-0845
  • Fax:
Mailing address:
  • Phone: 505-999-0845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICOLE GILKEY
Title or Position: CEO
Credential: GILKEY
Phone: 505-999-0845