| Wildflower Wellness, Llc | |
|
200 S Main St Ste P3 Pocatello ID 83204-3261 | |
| (208) 251-6789 | |
| Not Available |
| Full Name | Wildflower Wellness, Llc |
|---|---|
| Speciality | Counselor |
| Location | 200 S Main St Ste P3, Pocatello, Idaho |
| Authorized Official Name and Position | Misity D Olsen (OWNER) |
| Authorized Official Contact | 2082516789 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wildflower Wellness, Llc 200 S Main St Ste P3 Pocatello ID 83204-3261 Ph: (208) 251-6789 | Wildflower Wellness, Llc 200 S Main St Ste P3 Pocatello ID 83204-3261 Ph: (208) 251-6789 |
| NPI Number | 1700642840 |
|---|---|
| Provider Enumeration Date | 02/26/2024 |
| Last Update Date | 02/26/2024 |
| Certification Date | 02/26/2024 |
| Medicare PECOS PAC ID | 3476992835 |
|---|---|
| Medicare Enrollment ID | O20240417003925 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700642840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Misty D Olsen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1740880053 PECOS PAC ID: 2466897228 Enrollment ID: I20240301003856 |
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