Provider Demographics
NPI:1407620453
Name:WISE MINDS BY RHEA PLLC
Entity Type:Organization
Organization Name:WISE MINDS BY RHEA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:RHEA LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:218-999-0018
Mailing Address - Street 1:1255 S POKEGAMA AVE UNIT 11
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4208
Mailing Address - Country:US
Mailing Address - Phone:218-999-0018
Mailing Address - Fax:218-999-9627
Practice Address - Street 1:1255 S POKEGAMA AVE UNIT 11
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4208
Practice Address - Country:US
Practice Address - Phone:218-999-0018
Practice Address - Fax:218-999-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)