NPIMap

Organization Active NPI

Wild Minds Therapy, LLC

  • Adult Mental Health Clinic/Center
  • Perry Hall, MD
National Provider Identifier
1073365656
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
WILD MINDS THERAPY, LLC
Practice address
4401 Forge Rd
Perry Hall, MD 21128-9504
Phone
(443) 377-3644
NPI assigned
Apr 4, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Leah Childers, LCPCNPI 1396401147
Title
Owner/Therapist
Phone
(443) 377-3644

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

4401 Forge Rd
Perry Hall, MD 21128-9504

Mailing address

4401 Forge Rd
Perry Hall, MD 21128-9504
Phone (443) 377-3644

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1712188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1073365656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 FORGE RD",
            "city": "PERRY HALL",
            "state": "MD",
            "postal_code": "211289504",
            "telephone_number": "443-377-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 FORGE RD",
            "city": "PERRY HALL",
            "state": "MD",
            "postal_code": "211289504",
            "telephone_number": "443-377-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD MINDS THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-04",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "CHILDERS",
        "authorized_official_first_name": "LEAH",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "443-377-3644",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Perry Hall, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.