Healthcare Provider Details

I. General information

NPI: 1235041419
Provider Name (Legal Business Name): WILD CREEK THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 S WARNER ST APT D39
TACOMA WA
98409-5546
US

IV. Provider business mailing address

4525 S WARNER ST APT D39
TACOMA WA
98409-5546
US

V. Phone/Fax

Practice location:
  • Phone: 972-638-0040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER KRUEGER
Title or Position: OWNER
Credential: LPC, LMHC
Phone: 817-517-8537