MEDICARE: WISE MIND RELATIONSHIP COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841840873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE MIND RELATIONSHIP COUNSELING PLLC

Provider Business Mailing Address
First Line	:	2912 SALTWOOD CT
Second Line	:
City	:	CELINA
State	:	TX
Zip	:	75009-6584
Country	:	US
Telephone Number	:	425-281-0613
Fax Number	:

Provider Business Practice Location Address
First Line	:	5750 GENESIS CT STE 135
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-4229
Country	:	US
Telephone Number	:	425-686-5631
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA ANNE DELAPLACE
Credential	:	MSW, LICSW
Telephone Number	:	425-281-0613

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	06/07/2022

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