Organization
WILD TERRAIN THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE BOSMA LCSW-22050 (CEO)
(480) 798-2498
Entity
Organization
Contact information
Practice address
11811 N TATUM BLVD, PHOENIX, AZ 85028-1614
(480) 721-9593
Mailing address
PO BOX 31853, PHOENIX, AZ 85046-1853
(480) 721-9593
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/11/2024
Last updated
04/11/2024
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