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Organization
WILD PELORIA, LLC
Active
Organization
WILD PELORIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE WATSON LMFT, RPT-S (CLINICAL DIRECTOR)
(512) 966-4440
Entity
Organization
Contact information
Practice address
12035 SE GRAND VISTA DR, CLACKAMAS, OR 97015-8272
(512) 966-4440
Mailing address
12035 SE GRAND VISTA DR, CLACKAMAS, OR 97015-8272
(512) 966-4440
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
05/28/2025
Last updated
10/29/2025
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