Healthcare Provider Details

I. General information

NPI: 1790889012
Provider Name (Legal Business Name): WISE MIND SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 PLEASANT VALLEY ROAD
DIAMOND SPRINGS CA
95619
US

IV. Provider business mailing address

493 PLEASANT VALLEY ROAD
DIAMOND SPRINGS CA
95619
US

V. Phone/Fax

Practice location:
  • Phone: 530-620-7000
  • Fax:
Mailing address:
  • Phone: 530-620-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SABRINA OWEN-BALME
Title or Position: VICE PRESIDENT/ CFO
Credential:
Phone: 530-620-7000