Healthcare Provider Details

I. General information

NPI: 1083421671
Provider Name (Legal Business Name): WILDFLOWER COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 WASHINGTON RD
WASHINGTON PA
15301-9711
US

IV. Provider business mailing address

PO BOX 1534
WASHINGTON PA
15301-7534
US

V. Phone/Fax

Practice location:
  • Phone: 724-250-0262
  • Fax: 724-416-7102
Mailing address:
  • Phone: 724-250-0262
  • Fax: 724-416-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER MARSHALL
Title or Position: OWNER
Credential: MA, LPC, PMH-C
Phone: 724-250-0262