| Wyld Transformation | |
|
115 E 5th St Mountain Home AR 72653-3811 | |
| (928) 607-5531 | |
| Not Available |
| Full Name | Wyld Transformation |
|---|---|
| Speciality | Counselor - Professional |
| Location | 115 E 5th St, Mountain Home, Arkansas |
| Authorized Official Name and Position | Holly Skinner (CREDENTIALING) |
| Authorized Official Contact | 5014541664 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wyld Transformation 1483 Webber Rd Mountain Home AR 72653-6938 Ph: () - | Wyld Transformation 115 E 5th St Mountain Home AR 72653-3811 Ph: (928) 607-5531 |
| NPI Number | 1992578363 |
|---|---|
| Provider Enumeration Date | 11/06/2023 |
| Last Update Date | 08/19/2024 |
| Certification Date | 08/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992578363 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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