Wildwood Therapy Collective LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

WILDWOOD THERAPY COLLECTIVE LLC

Practice address

4032 Ewalt Rd
Gibsonia, PA 15044-9534

Phone

(802) 522-9211

NPI assigned

May 7, 2025

Organization subpart

No

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

Authorized official

Name

Jacob Edmondson, LPC, LCMHCNPI 1477374379

Title

Owner

Phone

(802) 522-9211

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VT, PA2 enrollments

Enrollment records 2

Locations

Practitioners 1

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

• Jacob Edmondson, MA

  • Mental Health Counselor
  • Montpelier, VT
  • NPI 1477374379

  PA

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1746576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772755200000",
    "number": "1831989482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4032 EWALT RD",
            "city": "GIBSONIA",
            "state": "PA",
            "postal_code": "150449534",
            "telephone_number": "802-522-9211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4032 EWALT RD",
            "city": "GIBSONIA",
            "state": "PA",
            "postal_code": "150449534",
            "telephone_number": "802-522-9211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11676 Perry Hwy Ste 2205",
            "address_purpose": "LOCATION",
            "city": "Wexford",
            "state": "PA",
            "postal_code": "150907201",
            "country_code": "US",
            "telephone_number": "802-522-9211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILDWOOD THERAPY COLLECTIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-07",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "status": "A",
        "authorized_official_last_name": "EDMONDSON",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "802-522-9211",
        "authorized_official_credential": "LPC, LCMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wesley Spectrum Services
• Wesley Spectrum Services
• Helena Jayne White, PHARMD
• Gwenn Catherine Whiteford, MS CCC SLP
• Joseph Wiegand, MOTR
• Brittany Wiles, DPT
• Nicholas A Wilson, D.M.D.
• Carolyn Wincer
• Tod A Wirtz, DMD
• Cheryl Wist, PTA

• Mental Health Counselor in Gibsonia, PA
• Providers in Gibsonia, PA by specialty
• Mental Health Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.