Wildform Therapy, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

WILDFORM THERAPY, PLLC

Practice address

201 W 8TH St Ste 880
Pueblo, CO 81003-3037

Phone

(719) 215-8347

NPI assigned

Sep 10, 2026

Last updated

Sep 10, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kurtis James Rivera, MAFP, MA, LPC, CAS

Title

Ceo

Phone

(719) 215-8347

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1788998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788998400000",
    "number": "1922918176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W 8TH ST STE 880",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033037",
            "telephone_number": "719-215-8347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W 8TH ST STE 880",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033037",
            "telephone_number": "719-215-8347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDFORM THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-10",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "KURTIS",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "719-215-8347",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MAFP, MA, LPC, CAS"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mandie Leigh Wiant
• Erik Matthews Wickstrum, CRNA
• Samuel Lawrence Widdowson, FNP-BC
• William Donald Wierman, MD
• Kori Wilcutt
• Alex Wiley, M.ED
• Brandon Wiley, DPT
• Laronza Ronquinette Wiley
• Matthew W Wilkins
• Krista Elizabeth Wilks, D.C.

• Mental Health Counselor in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Mental Health Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; 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.