Healthcare Provider Details

I. General information

NPI: 1194688556
Provider Name (Legal Business Name): WANDERING MINDS COUNSELING & CONSULTING, 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

727 SE CASS AVE STE 206
ROSEBURG OR
97470-4953
US

IV. Provider business mailing address

727 SE CASS AVE STE 206
ROSEBURG OR
97470-4953
US

V. Phone/Fax

Practice location:
  • Phone: 541-378-1186
  • Fax: 541-391-7220
Mailing address:
  • Phone: 541-378-1186
  • Fax: 541-391-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA DAVIDSON
Title or Position: OWNER
Credential: LCSW
Phone: 541-378-1186