Provider Demographics
NPI:1689309437
Name:WISEMIND INC
Entity Type:Organization
Organization Name:WISEMIND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO
Authorized Official - Prefix:
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RATTANAPICHETKUL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-552-5994
Mailing Address - Street 1:705 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2446
Mailing Address - Country:US
Mailing Address - Phone:626-344-8036
Mailing Address - Fax:
Practice Address - Street 1:705 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2446
Practice Address - Country:US
Practice Address - Phone:626-344-8036
Practice Address - Fax:626-316-6761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty