WILD HERON PLLC NPI 1104636968

NPI Information

  • NPI: 1104636968
  • Provider Name: WILD HERON PLLC
  • Classification: Clinic/Center - 261QM0801X
  • Specialization: Mental Health (Including Community Mental Health Center)
  • Entity Type: Organization
  • Address: 38169 US HIGHWAY 50
    GUNNISON, CO
    ZIP 81230
  • Phone: (917) 664-6582

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NPI Details

WILD HERON PLLC is a mental health (including community mental health center) clinic center in Gunnison, CO. WILD HERON PLLC NPI is 1104636968. The provider is registered as an organization entity type.

The provider's business location address is:

38169 US HIGHWAY 50
GUNNISON, CO
ZIP 81230-730
Phone: (917) 664-6582

The provider's authorized official is Eliza Kate Wicks-arshack .
The authorized official title is Owner, Therapist and has the following contact phone number (917) 664-6582.

The enumeration date for this NPI number is 1/13/2025 and was last updated on 1/13/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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