Healthcare Provider Details

I. General information

NPI: 1730042219
Provider Name (Legal Business Name): WISDOM FROM WOUNDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 76TH ST UNIT 3025
WEST DES MOINES IA
50266-5913
US

IV. Provider business mailing address

1045 76TH ST UNIT 3025
WEST DES MOINES IA
50266-5913
US

V. Phone/Fax

Practice location:
  • Phone: 515-337-9309
  • Fax:
Mailing address:
  • Phone: 515-337-9309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA ADELL RIVES
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 515-337-9309