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General NPI Number Information
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NPI Number | 1659930519
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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 | 06/13/2019
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 2961 YARMOUTH GREENWAY DR STE 2
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City | FITCHBURG
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State | WI
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Zip | 53711-5809
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Country | US
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Telephone | 608-571-4143
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Fax | 608-531-2790
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Provider Business Mailing Address
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Address Line | 2961 YARMOUTH GREENWAY DR STE 2
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City | FITCHBURG
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State | WI
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Zip | 53711-5809
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Country | US
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Telephone | 608-571-4143
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Fax | 608-531-2790
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MISS LEE (HAYLEY) AMANDA CLARK
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Credential | M.S. LMFT
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Telephone | 608-531-4143
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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