Provider Demographics
NPI:1417704149
Name:WILDFLOWER BEHAVIORAL CONSULTING, LLC.
Entity type:Organization
Organization Name:WILDFLOWER BEHAVIORAL CONSULTING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:SKYE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:904-240-6800
Mailing Address - Street 1:2607 VENTURA CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-7468
Mailing Address - Country:US
Mailing Address - Phone:904-240-6800
Mailing Address - Fax:
Practice Address - Street 1:2607 VENTURA CIR
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-7468
Practice Address - Country:US
Practice Address - Phone:904-240-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health