Tiffany A Wild

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

2022037460 Issued in MO

Practice address

15455 Conway Rd Ste 117
Chesterfield, MO 63017-2022

Phone

(636) 466-3077

NPI assigned

Aug 6, 2024

Sex

Female

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Chesterfield Counseling Associates, LLC

  • Counselor
  • Chesterfield, MO
  • NPI 1093361784
  NPD

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

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1578393278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15455 CONWAY RD STE 117",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172022",
            "telephone_number": "636-466-3077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15455 CONWAY RD STE 117",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630172022",
            "telephone_number": "636-466-3077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "TIFFANY",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MO",
            "license": "2022037460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Whicker, MD
• Pleasant White, L.P.C
• Tyler White, D.C.
• Donna Marie Whitley, FNP-BC
• Stephanie Lee Whitley, D.M.D.
• Timothy Devin Wilhelm
• Angela Wilkerson, RPH
• Kenneth Wilkes
• Margaret H Will, CRNA
• Steven F Willey, MD

• Mental Health Counselor in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Mental Health Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.