Wild North Counseling LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WILD NORTH COUNSELING LLC

Practice address

41 Depot St Ste 204
Bridgton, ME 04009-2298

Phone

(207) 803-8735

NPI assigned

Sep 9, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tighe Blackadar, LCSWNPI 1508471095

Title

Owner

Phone

(207) 803-8735

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tighe Blackadar, MSW, LCSW

  • Clinical Social Worker
  • Bridgton, ME
  • NPI 1508471095
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1725840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725840000000",
    "number": "1174359012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 DEPOT ST STE 204",
            "city": "BRIDGTON",
            "state": "ME",
            "postal_code": "040092298",
            "telephone_number": "207-803-8735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 DEPOT ST STE 204",
            "city": "BRIDGTON",
            "state": "ME",
            "postal_code": "040092298",
            "telephone_number": "207-803-8735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD NORTH COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-09",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "BLACKADAR",
        "authorized_official_first_name": "TIGHE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "207-803-8735",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Eastern Co Inc
• Kimberly Ann Walker, LCSW
• Christine Warrick, FNP
• Madeline Welch
• Ronald Welch, PA
• Lauren Iva-Bennett Wilson, OTR/L
• Woodlands Senior Living of Bridgton
• Ty Gabriel Wyman

• Clinical Social Worker in Bridgton, ME
• Providers in Bridgton, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.