=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801708839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILDFLOWER TRAUMA AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2026
-----------------------------------------------------
Last Update Date | 09/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 KING ST
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06010-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-795-6695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 63 ENO AVE
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-795-6695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/FOUNDER
-----------------------------------------------------
Name | MORGAN EVANS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-795-6695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------