Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Wild Peloria, LLC

Organization Mental Health Counselor · NPI 1033902382

Wild Peloria, LLC is a Mental Health Counselor in Clackamas, Oregon. Registered with an NPI since 2025.

In the registry since
2025
Specialties on file
4
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12035 SE Grand Vista Dr
Clackamas, OR 97015-8272
Phone: (512) 966-4440
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X
Professional Counselor Taxonomy 101YP2500X
Clinical Social Worker Taxonomy 1041C0700X
Marriage & Family Therapist Taxonomy 106H00000X

Record details

NPI number1033902382
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jamie Watson — Clinical Director · (512) 966-4440
NPI enumeratedMay 28, 2025
Last updated in NPPESOctober 29, 2025
Certification dateOctober 29, 2025
Mailing address12035 Se Grand Vista Dr, Clackamas, OR 97015-8272

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