Provider Demographics
NPI:1386193654
Name:WISDOM THERAPY LLC
Entity Type:Organization
Organization Name:WISDOM THERAPY LLC
Other - Org Name:STEPPING STONES COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WISDOM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-247-2025
Mailing Address - Street 1:419 COUNTY ROAD 734
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63633-8309
Mailing Address - Country:US
Mailing Address - Phone:573-247-2025
Mailing Address - Fax:573-689-1391
Practice Address - Street 1:201 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MO
Practice Address - Zip Code:65560-1423
Practice Address - Country:US
Practice Address - Phone:573-739-1289
Practice Address - Fax:573-739-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005024364101YP2500X
MO20140183081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty