Wild Heart Society PLLC

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

WILD HEART SOCIETY PLLC

Practice address

15604 NE 28TH Ave
Vancouver, WA 98686-1541

Phone

(360) 521-3055

NPI assigned

Mar 4, 2019

Organization subpart

No

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

Authorized official

Name

Mackenzie Dunham, LCSW

Title

Partner/Therapist

Phone

(360) 521-3055

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1551657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551657600000",
    "number": "1700344298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15604 NE 28TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986861541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15604 NE 28TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986861541",
            "telephone_number": "360-521-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD HEART SOCIETY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-04",
        "last_updated": "2019-03-04",
        "status": "A",
        "authorized_official_last_name": "DUNHAM",
        "authorized_official_first_name": "MACKENZIE",
        "authorized_official_title_or_position": "PARTNER/THERAPIST",
        "authorized_official_telephone_number": "360-521-3055",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Wilbanks
• Brandon Michael Wilburn, DMD
• Danielle Renee Wilcox, BA
• Evelyn J Wilcox, C.R.N.A.
• Lee A Wilcox, M.D.
• William Roy Wilde, DMD
• Isaac Junior Wilder II
• Tanya M Wilder
• Julia W Wildes, MD
• Christina Lynne Wiles

• Adolescent and Children Mental Health Clinic/Center in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Adolescent and Children Mental Health Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; 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.