NPIMap

Organization Active NPI

Wilder Wellness LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bend, OR
National Provider Identifier
1255032926
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
WILDER WELLNESS LLC
Practice address
20225 Jonathon CT
Bend, OR 97703-8764
Phone
(458) 206-0904
NPI assigned
Mar 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

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

Authorized official

Name
Kristen Ales, MA, LPCNPI 1609478759
Title
Ceo, Therapist
Phone
(831) 345-2951

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

20225 Jonathon CT
Bend, OR 97703-8764

Mailing address

70 SW Century Dr
Ste 100 PMB 1076
Bend, OR 97702

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1678406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678406400000",
    "number": "1255032926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 SW CENTURY DR",
            "address_2": "STE 100 PMB 1076",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20225 JONATHON CT",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977038764",
            "telephone_number": "458-206-0904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDER WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-10",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A",
        "authorized_official_last_name": "ALES",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "CEO, THERAPIST",
        "authorized_official_telephone_number": "831-345-2951",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; 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.