Randy Wild, LCPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C1740 Issued in OR

Practice address

3152 S Bown Way Ste 103
Boise, ID 83706-5456

Phone

(541) 550-7940

Fax

(541) 550-7941

NPI assigned

Jun 13, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 13, 2025 through Feb 13, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bend Counseling & Biofeedback, Inc.

  • Professional Counselor
  • Bend, OR
  • NPI 1558603373
  NPD (past) Authorized official

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707868800000",
    "number": "1295939080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3152 S BOWN WAY STE 103",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837065456",
            "telephone_number": "541-550-7940",
            "fax_number": "541-550-7941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3152 S BOWN WAY STE 103",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837065456",
            "telephone_number": "541-550-7940",
            "fax_number": "541-550-7941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "RANDY",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-13",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C1740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wil'S Transit
• Melissa Wilburn
• Wild Heart Living
• Wild Milk PLLC
• Wild Sage Counseling & Wellness PLLC
• Wildflower Intuitive Center, LLC
• Wildflower OBGYN LLC
• Wildflower Telehealth Network Inc.
• Brandon J Wilding, M.D.
• Victoria Chlarson Wilding, MD

• Mental Health Counselor in Boise, ID
• Providers in Boise, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.