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General NPI Number Information
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NPI Number | 1669286688
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Entity Type | Organization
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Legal Business Name | WILDFLOWER MENTAL HEALTH COUNSELING, LLC
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 906 DELAWARE AVE
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City | FORT PIERCE
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State | FL
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Zip | 34950-8518
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Country | US
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Telephone | 772-202-5661
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Fax | 772-228-4309
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Provider Business Mailing Address
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Address Line | 1901 SW CERTOSA RD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-1369
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Country | US
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Telephone | 772-202-5661
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Fax | 772-228-4309
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | LISA MARIE NICOLETTE
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Credential | LMHC
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Telephone | 772-202-5661
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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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