MEDICARE: WILD BLUEBONNET COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1457285595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILD BLUEBONNET COUNSELING, LLC

Provider Business Mailing Address
First Line	:	3200 WILCREST DRIVE
Second Line	:	SUITE 170 PMB 70767
City	:	HOUSTON
State	:	TX
Zip	:	77042
Country	:	US
Telephone Number	:	806-319-1161
Fax Number	:

Provider Business Practice Location Address
First Line	:	14710 OVERVIEW DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75254-8124
Country	:	US
Telephone Number	:	806-319-1161
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOLLY PROPST
Credential	:	LPC
Telephone Number	:	806-319-1161

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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