=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144100645
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILDFLOWER WELLNESS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16960 W BELL RD STE 502
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-8937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-695-6077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16960 W BELL RD STE 502
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85374-8937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-695-6077
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LPC
-----------------------------------------------------
Name | MRS. CASSIDY GALLIMORE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 602-695-6077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------