Provider Demographics
NPI:1265237986
Name:WILDFLOWER MENTAL HEALTH THERAPY LLC
Entity type:Organization
Organization Name:WILDFLOWER MENTAL HEALTH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-245-9493
Mailing Address - Street 1:343 S MAIN ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2116
Mailing Address - Country:US
Mailing Address - Phone:734-245-9493
Mailing Address - Fax:
Practice Address - Street 1:343 S MAIN ST STE 200A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2116
Practice Address - Country:US
Practice Address - Phone:734-245-9493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty