NPIMap

Organization Active NPI

Wise CCC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Decatur, TX
National Provider Identifier
1407504939
Registry record updated Mar 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
WISE CCC
Practice address
1650 S FM 51 Ste 400
Decatur, TX 76234-3630
Phone
(940) 627-1618
Fax
(940) 393-0429
NPI assigned
Mar 14, 2022
Last updated
Mar 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2022

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

Authorized official

Name
Beverly Joann Ross, M.A., LPC-SNPI 1861140451
Title
Executive Director
Phone
(940) 627-1618

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

1650 S FM 51 Ste 400
Decatur, TX 76234-3630

Mailing address

1650 S FM 51 Ste 400
Decatur, TX 76234-3630
Phone (940) 627-1618

National Provider Directory

National Provider Directory

Locations

1650 S FM 51
Ste 400
Decatur, TX 76234
Phone (940) 389-9010

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1647216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1407504939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 S FM 51 STE 400",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343630",
            "telephone_number": "940-627-1618",
            "fax_number": "940-393-0429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 S FM 51 STE 400",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343630",
            "telephone_number": "940-627-1618",
            "fax_number": "940-393-0429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE CCC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-14",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_middle_name": "JOANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "940-627-1618",
        "authorized_official_credential": "M.A., LPC-S"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; 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.