Provider Demographics
NPI:1942953195
Name:WILDFLOWER BEHAVIORAL CONSULTING LLC
Entity Type:Organization
Organization Name:WILDFLOWER BEHAVIORAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:SKYE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:904-240-6800
Mailing Address - Street 1:17 CLEMENT DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1101
Mailing Address - Country:US
Mailing Address - Phone:904-240-6800
Mailing Address - Fax:
Practice Address - Street 1:17 CLEMENT DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1101
Practice Address - Country:US
Practice Address - Phone:904-240-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty