NPIMap

Organization Active NPI

Wise Mind PLLC

  • Clinical Psychologist
  • Ypsilanti, MI
National Provider Identifier
1982147302
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
WISE MIND PLLC
Practice address
127 N Washington St
Ypsilanti, MI 48197-2619
Phone
(734) 682-5544
NPI assigned
Dec 2, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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

Authorized official

Name
Dr. Antoinette Crocilla, PSYD LPNPI 1861828410
Title
Psychologist/Owner
Phone
(517) 499-0991

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
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

127 N Washington St
Ypsilanti, MI 48197-2619

Mailing address

127 N Washington St
Ypsilanti, MI 48197-2619
Phone (734) 682-5544

National Provider Directory

National Provider Directory

Locations

127 N Washington St
Ypsilanti, MI 48197
Phone (734) 682-5544

Practitioners & affiliated clinicians

Practitioners 12

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": "1480636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644796800000",
    "number": "1982147302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 N WASHINGTON ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481972619",
            "telephone_number": "734-682-5544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 N WASHINGTON ST",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481972619",
            "telephone_number": "734-682-5544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE MIND PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-02",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A",
        "authorized_official_last_name": "CROCILLA",
        "authorized_official_first_name": "ANTOINETTE",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "517-499-0991",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD LP"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

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