Provider Demographics
NPI:1437036258
Name:WISE MIND BEHAVIORAL
Entity type:Organization
Organization Name:WISE MIND BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-308-2307
Mailing Address - Street 1:176 THOMAS JOHNSON DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4538
Mailing Address - Country:US
Mailing Address - Phone:240-608-2307
Mailing Address - Fax:
Practice Address - Street 1:176 THOMAS JOHNSON DR STE 204
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4538
Practice Address - Country:US
Practice Address - Phone:240-608-2307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty