Provider Demographics
NPI:1326727694
Name:WILDFLOWER THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:WILDFLOWER THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:AIGNER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:304-449-4926
Mailing Address - Street 1:1253 CANYON RD STE 9
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-9273
Mailing Address - Country:US
Mailing Address - Phone:304-449-4926
Mailing Address - Fax:
Practice Address - Street 1:1253 CANYON RD STE 9
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-9273
Practice Address - Country:US
Practice Address - Phone:304-449-4926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty