Provider Demographics
NPI:1376288928
Name:WILDFLOWER BEHAVIOR SERVICES, LLC
Entity Type:Organization
Organization Name:WILDFLOWER BEHAVIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:830-992-8083
Mailing Address - Street 1:PO BOX 2365
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-1921
Mailing Address - Country:US
Mailing Address - Phone:830-992-8083
Mailing Address - Fax:
Practice Address - Street 1:704 SHUMARD LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-2762
Practice Address - Country:US
Practice Address - Phone:830-992-8083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty