Provider Demographics
NPI:1023904554
Name:WILD SAGE COUNSELING & WELLNESS PLLC
Entity type:Organization
Organization Name:WILD SAGE COUNSELING & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-890-3593
Mailing Address - Street 1:11393 N 20TH PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2255
Mailing Address - Country:US
Mailing Address - Phone:208-890-3593
Mailing Address - Fax:
Practice Address - Street 1:11393 N 20TH PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-2255
Practice Address - Country:US
Practice Address - Phone:208-890-3593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty