Wise Mind Online Therapy

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

WISE MIND ONLINE THERAPY

Practice address

16252 E 3Rd St
Bayview, ID 83803-8002

Phone

(208) 243-3332

NPI assigned

Dec 28, 2022

Last updated

Dec 28, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Travis Reed Stephens, LCSW

Title

Owner

Phone

(208) 243-3332

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1672185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672185600000",
    "number": "1831802446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16252 E 3RD ST",
            "city": "BAYVIEW",
            "state": "ID",
            "postal_code": "838038002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16252 E 3RD ST",
            "city": "BAYVIEW",
            "state": "ID",
            "postal_code": "838038002",
            "telephone_number": "208-243-3332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE MIND ONLINE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-28",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "TRAVIS",
        "authorized_official_middle_name": "REED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-243-3332",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabitha McGovern
• Round-Up Transportation II LLC

• Adult Mental Health Clinic/Center in Bayview, ID
• Providers in Bayview, ID by specialty
• Adult Mental Health Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.