Wild Terrain Therapy LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

WILD TERRAIN THERAPY LLC

Practice address

11811 N Tatum Blvd
Phoenix, AZ 85028-1614

Phone

(480) 721-9593

NPI assigned

Apr 11, 2024

Organization subpart

No

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

Authorized official

Name

Danielle Bosma, LCSW-22050NPI 1407599038

Title

Ceo

Phone

(480) 798-2498

Specialties & licenses 1

Addresses

Practitioners 1

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

• Danielle M Bosma, LCSW

  • Clinical Social Worker
  • Phoenix, AZ
  • NPI 1407599038
  NPD Authorized official

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

{
    "created_epoch": "1712793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1538912134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31853",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850461853",
            "telephone_number": "480-721-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11811 N TATUM BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850281614",
            "telephone_number": "480-721-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD TERRAIN THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-11",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "BOSMA",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "480-798-2498",
        "authorized_official_credential": "LCSW-22050"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Rose Wilcott
• Amanda Wilcox, COTA/L
• Lauren Wilcox, PA-C
• Wild Hearts Rise
• Wild Roots Wellness, PLLC
• Jennifer Wild, D.O.
• Reece Wild, PA-C
• Susanne Gertraud Wild, M.D.
• Jolyn M. Wilda, CRNA
• Laura Mary Wilda, MSN, FNP-C

• Clinical Social Worker in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 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.