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General NPI Number Information
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NPI Number | 1760190078
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Entity Type | Organization
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Legal Business Name | WILD & FREE BEHAVIOR, LLC
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 403 DOCTORS DR
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City | NEW ALBANY
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State | MS
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Zip | 38652-3110
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Country | US
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Telephone | 662-539-7129
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Fax | 662-539-7298
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Provider Business Mailing Address
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Address Line | 403 DOCTORS DR
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City | NEW ALBANY
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State | MS
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Zip | 38652-3110
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Country | US
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Telephone | 662-539-7129
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Fax | 662-539-7298
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Authorized Official
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Title or Position | BCBA/OWNER
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Name | MRS. ANNA CLAIRE WALDROP
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Credential | M.S., BCBA, LBA
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Telephone | 662-538-8657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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