Provider Demographics
NPI:1215799093
Name:WILD WELLNESS INC.
Entity type:Organization
Organization Name:WILD WELLNESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAWCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:413-591-9355
Mailing Address - Street 1:230 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTERLITZ
Mailing Address - State:NY
Mailing Address - Zip Code:12017-1725
Mailing Address - Country:US
Mailing Address - Phone:413-591-9355
Mailing Address - Fax:413-429-4342
Practice Address - Street 1:449 PITTSFIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2107
Practice Address - Country:US
Practice Address - Phone:413-591-9355
Practice Address - Fax:413-429-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty