Provider Demographics
NPI:1972041267
Name:WISE MIND THERAPY & COUNSELING LLC
Entity Type:Organization
Organization Name:WISE MIND THERAPY & COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-933-3986
Mailing Address - Street 1:10 HIGGINS HWY STE 14
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1437
Mailing Address - Country:US
Mailing Address - Phone:860-933-9937
Mailing Address - Fax:860-228-8106
Practice Address - Street 1:10 HIGGINS HWY STE 14
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:860-933-9937
Practice Address - Fax:860-228-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003082101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty