Provider Demographics
NPI:1679034755
Name:WISE MIND AUSTIN, PLLC
Entity Type:Organization
Organization Name:WISE MIND AUSTIN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT-S
Authorized Official - Phone:512-665-3499
Mailing Address - Street 1:2028E BEN WHITE BLVD
Mailing Address - Street 2:STE 240 PMB 3499
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6931
Mailing Address - Country:US
Mailing Address - Phone:512-665-3499
Mailing Address - Fax:
Practice Address - Street 1:5008 RANCH ACRES DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-1638
Practice Address - Country:US
Practice Address - Phone:512-665-3499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)