Provider Demographics
NPI:1386253003
Name:WILD HOPE THERAPY, LLC
Entity type:Organization
Organization Name:WILD HOPE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PURDOM
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:630-404-7833
Mailing Address - Street 1:3295 KENMORE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3456
Mailing Address - Country:US
Mailing Address - Phone:630-404-7833
Mailing Address - Fax:
Practice Address - Street 1:3040 RIVERSIDE DR STE 117
Practice Address - Street 2:
Practice Address - City:UPPER ARLNGTN
Practice Address - State:OH
Practice Address - Zip Code:43221-2550
Practice Address - Country:US
Practice Address - Phone:614-328-9714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty