Provider Demographics
NPI:1629803101
Name:WILD SOUL WELL-BEING PLLC
Entity type:Organization
Organization Name:WILD SOUL WELL-BEING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPP
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:720-507-8455
Mailing Address - Street 1:870 S COLORADO BLVD # 1172
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2080
Mailing Address - Country:US
Mailing Address - Phone:720-507-8455
Mailing Address - Fax:
Practice Address - Street 1:870 S COLORADO BLVD # 1172
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-2080
Practice Address - Country:US
Practice Address - Phone:720-507-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health