Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Wildform Therapy, PLLC

Organization Mental Health Counselor · NPI 1922918176

Wildform Therapy, PLLC provides Mental Health Counselor services in Pueblo, Colorado. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

201 W 8th St Ste 880
Pueblo, CO 81003-3037
Phone: (719) 215-8347
Show map & directions

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

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1922918176
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kurtis Rivera — Ceo · (719) 215-8347
NPI enumeratedSeptember 10, 2026
Last updated in NPPESSeptember 10, 2026
Certification dateSeptember 10, 2026
Mailing address201 W 8th St Ste 880, Pueblo, CO 81003-3037

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