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General NPI Number Information
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NPI Number | 1083421671
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Entity Type | Organization
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Legal Business Name | WILDFLOWER COUNSELING AND WELLNESS, LLC
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 1445 WASHINGTON RD
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City | WASHINGTON
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State | PA
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Zip | 15301-9711
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Country | US
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Telephone | 724-250-0262
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Fax | 724-416-7102
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Provider Business Mailing Address
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Address Line | PO BOX 1534
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City | WASHINGTON
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State | PA
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Zip | 15301-7534
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Country | US
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Telephone | 724-250-0262
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Fax | 724-416-7102
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER MARSHALL
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Credential | MA, LPC, PMH-C
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Telephone | 724-250-0262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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