Provider Demographics
NPI:1245061373
Name:WILDLY WELL COUNSELING AND EMPOWERMENT
Entity type:Organization
Organization Name:WILDLY WELL COUNSELING AND EMPOWERMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S, LCDCIII
Authorized Official - Phone:440-855-5246
Mailing Address - Street 1:PO BOX 2824
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-2824
Mailing Address - Country:US
Mailing Address - Phone:440-855-5246
Mailing Address - Fax:
Practice Address - Street 1:617 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-2535
Practice Address - Country:US
Practice Address - Phone:440-855-5246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-10
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)