=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861367278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILDFLOWERS MENTAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2025
-----------------------------------------------------
Last Update Date | 01/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 936 HIGHWAY 51 N
-----------------------------------------------------
City | RIPLEY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38063-8049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-324-3061
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 180 CHISHOLM LAKE RD
-----------------------------------------------------
City | RIPLEY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38063-5802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-324-3061
-----------------------------------------------------
Fax | 806-606-0691
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MBR
-----------------------------------------------------
Name | BREIANNE CHISHOLM
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 731-589-0420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------