Provider Demographics
NPI:1447025572
Name:WISE MINDS THERAPY, PLLC
Entity type:Organization
Organization Name:WISE MINDS THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-257-6257
Mailing Address - Street 1:1618 CURTIS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-6332
Mailing Address - Country:US
Mailing Address - Phone:217-257-6257
Mailing Address - Fax:
Practice Address - Street 1:3837 E LAKE CTR STE 400
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5803
Practice Address - Country:US
Practice Address - Phone:217-257-6257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty