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General NPI Number Information
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NPI Number | 1487592556
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Entity Type | Organization
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Legal Business Name | WILDFLOWER COUNSELING LLC
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 917 SW OAK ST STE 417
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City | PORTLAND
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State | OR
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Zip | 97205-2807
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Country | US
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Telephone | 971-385-4702
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Fax | 971-328-4653
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Provider Business Mailing Address
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Address Line | 917 SW OAK ST STE 417
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City | PORTLAND
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State | OR
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Zip | 97205-2807
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Country | US
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Telephone | 971-385-4702
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Fax | 971-328-4653
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. WILLA BEAN JUTZI SHAW
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Credential | LPC
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Telephone | 971-385-4702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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