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Organization
WILDFORM THERAPY, PLLC
Active
Organization
WILDFORM THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KURTIS JAMES RIVERA MAFP, MA, LPC, CAS (CEO)
(719) 215-8347
Entity
Organization
Contact information
Practice address
201 W 8TH ST STE 880, PUEBLO, CO 81003-3037
(719) 215-8347
Mailing address
201 W 8TH ST STE 880, PUEBLO, CO 81003-3037
(719) 215-8347
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/10/2026
Last updated
09/10/2026
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