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

Nicole Wildeman

Individual provider Professional Counselor · NPI 1417605833

Nicole Wildeman is a Mental Health Counselor in Fenton, Michigan. Qualified in 2014, 12 years ago. Practices with Brightside Medical of Michigan PC, a 93-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Florida and Michigan.

Years since qualifying
12
Licensed in
FL, MI
In the registry since
2022
Specialties on file
2

Practice location Address checks out

14229 Torrey Rd # 3
Fenton, MI 48430-3308
Phone: (810) 214-2624
Show map & directions

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

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 6401222623 (MI)
Mental Health Counselor Taxonomy 101YM0800X · Licence TPMC5026 (FL)

Record details

NPI number1417605833
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 15, 2022
Last updated in NPPESApril 9, 2026
Certification dateApril 9, 2026
Mailing address2421 Golden Shore Dr, Fenton, MI 48430-1058

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Brightside Medical Of Michigan Pc — 93 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Fenton