| Wild Terrain Therapy Llc | |
|
11811 N Tatum Blvd Phoenix AZ 85028-1614 | |
| (480) 721-9593 | |
| Not Available |
| Full Name | Wild Terrain Therapy Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 11811 N Tatum Blvd, Phoenix, Arizona |
| Authorized Official Name and Position | Danielle Bosma (CEO) |
| Authorized Official Contact | 4807982498 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Terrain Therapy Llc Po Box 31853 Phoenix AZ 85046-1853 Ph: (480) 721-9593 | Wild Terrain Therapy Llc 11811 N Tatum Blvd Phoenix AZ 85028-1614 Ph: (480) 721-9593 |
| NPI Number | 1538912134 |
|---|---|
| Provider Enumeration Date | 04/11/2024 |
| Last Update Date | 04/11/2024 |
| Certification Date | 04/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538912134 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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