Provider Demographics
NPI:1326850629
Name:WILDFLOWER PSYCHOLOGY AND CONSULTING, LLC
Entity type:Organization
Organization Name:WILDFLOWER PSYCHOLOGY AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEELY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:406-861-9530
Mailing Address - Street 1:2011 W DANFORTH RD # 123
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-4685
Mailing Address - Country:US
Mailing Address - Phone:406-861-9530
Mailing Address - Fax:
Practice Address - Street 1:5835 TIMBERLAND XING
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-4441
Practice Address - Country:US
Practice Address - Phone:406-861-9530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical