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General NPI Number Information
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NPI Number | 1326850629
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Entity Type | Organization
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Legal Business Name | WILDFLOWER PSYCHOLOGY AND CONSULTING, LLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/01/2026
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Provider Practice Location Address
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Address Line | 2529 S KELLY AVE STE B
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City | EDMOND
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State | OK
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Zip | 73013-2976
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Country | US
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Telephone | 405-454-8016
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Fax | 405-583-4963
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Provider Business Mailing Address
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Address Line | 2529 S KELLY AVE STE B
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City | EDMOND
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State | OK
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Zip | 73013-2976
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Country | US
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Telephone | 405-454-8016
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Fax | 405-583-4963
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KEELY RAE JOHNSON
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Credential | PSYD
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Telephone | 406-861-9530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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