| Wildflower Mental Health Pllc | |
|
919 S 7th St Ste 401 Bismarck ND 58504-5835 | |
| (701) 751-1579 | |
| (701) 401-0115 |
| Full Name | Wildflower Mental Health Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 919 S 7th St Ste 401, Bismarck, North Dakota |
| Authorized Official Name and Position | Amanda Kouba (OWNER) |
| Authorized Official Contact | 7016994052 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wildflower Mental Health Pllc 919 S 7th St Ste 401 Bismarck ND 58504-5835 Ph: (701) 751-1579 | Wildflower Mental Health Pllc 919 S 7th St Ste 401 Bismarck ND 58504-5835 Ph: (701) 751-1579 |
| NPI Number | 1710751607 |
|---|---|
| Provider Enumeration Date | 11/10/2023 |
| Last Update Date | 02/27/2024 |
| Certification Date | 02/27/2024 |
| Medicare PECOS PAC ID | 7113363458 |
|---|---|
| Medicare Enrollment ID | O20240309000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710751607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Amanda Kouba |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528577814 PECOS PAC ID: 1153689666 Enrollment ID: I20171211000554 |
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