Provider Demographics
NPI:1881131696
Name:WISDOM TREATMENT, LLC
Entity type:Organization
Organization Name:WISDOM TREATMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BARSALOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-312-9611
Mailing Address - Street 1:3031 N SAN FERNANDO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4704
Mailing Address - Country:US
Mailing Address - Phone:424-208-9829
Mailing Address - Fax:
Practice Address - Street 1:3031 N SAN FERNANDO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4704
Practice Address - Country:US
Practice Address - Phone:424-208-9829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty