Provider Demographics
NPI:1639768369
Name:A WILDER COUNSELING
Entity Type:Organization
Organization Name:A WILDER COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LAC
Authorized Official - Phone:620-804-2942
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67529-0042
Mailing Address - Country:US
Mailing Address - Phone:620-804-2942
Mailing Address - Fax:
Practice Address - Street 1:215 FIRST ST
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:KS
Practice Address - Zip Code:67529-2976
Practice Address - Country:US
Practice Address - Phone:620-804-2942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty