Provider Demographics
NPI:1790160752
Name:WISE MIND BEHAVIORAL THERAPY LLC
Entity Type:Organization
Organization Name:WISE MIND BEHAVIORAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'LAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:206-883-4906
Mailing Address - Street 1:6505 218TH ST SW STE 14
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2135
Mailing Address - Country:US
Mailing Address - Phone:206-883-4906
Mailing Address - Fax:206-316-2309
Practice Address - Street 1:6505 218TH ST SW STE 14
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2135
Practice Address - Country:US
Practice Address - Phone:206-883-4906
Practice Address - Fax:206-316-2309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602227861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty