Provider Demographics
NPI:1891402160
Name:WILD WOMAN COUNSELING AND WELLNESS
Entity Type:Organization
Organization Name:WILD WOMAN COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:IMFT
Authorized Official - Phone:419-605-8229
Mailing Address - Street 1:533 S HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2022
Mailing Address - Country:US
Mailing Address - Phone:419-605-8229
Mailing Address - Fax:
Practice Address - Street 1:533 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2022
Practice Address - Country:US
Practice Address - Phone:419-605-8229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)