Provider Demographics
NPI:1760190078
Name:WILD & FREE BEHAVIOR, LLC
Entity Type:Organization
Organization Name:WILD & FREE BEHAVIOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:WALDROP
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:662-538-8657
Mailing Address - Street 1:403 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3110
Mailing Address - Country:US
Mailing Address - Phone:662-539-7129
Mailing Address - Fax:662-539-7298
Practice Address - Street 1:403 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3110
Practice Address - Country:US
Practice Address - Phone:662-539-7129
Practice Address - Fax:662-539-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health