Provider Demographics
NPI:1508491762
Name:WILD THISTLE THERAPY LLC
Entity Type:Organization
Organization Name:WILD THISTLE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROPP
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-296-2626
Mailing Address - Street 1:1333 GULF BREEZE PKWY
Mailing Address - Street 2:#1021
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563
Mailing Address - Country:US
Mailing Address - Phone:850-296-2626
Mailing Address - Fax:
Practice Address - Street 1:2990 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563
Practice Address - Country:US
Practice Address - Phone:850-296-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty