Provider Demographics
NPI:1699337493
Name:WILDFLOWER WELLNESS & COUNSELING, PLLC
Entity type:Organization
Organization Name:WILDFLOWER WELLNESS & COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-528-1527
Mailing Address - Street 1:506 CALVIN DEES ST
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-2519
Mailing Address - Country:US
Mailing Address - Phone:601-528-1527
Mailing Address - Fax:
Practice Address - Street 1:506 CALVIN DEES ST
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-2519
Practice Address - Country:US
Practice Address - Phone:601-528-1527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)