Healthcare Provider Details

I. General information

NPI: 1730828120
Provider Name (Legal Business Name): WISDOM MOUNTAIN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 COOLEYVILLE RD
SHUTESBURY MA
01072-9766
US

IV. Provider business mailing address

PO BOX 682
SHUTESBURY MA
01072-0682
US

V. Phone/Fax

Practice location:
  • Phone: 978-407-4806
  • Fax:
Mailing address:
  • Phone:
  • 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: MRS. RACHEL SCHWAB
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 978-407-4806