Healthcare Provider Details

I. General information

NPI: 1497627574
Provider Name (Legal Business Name): OPENEDEYES COUNSELING & MENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W 12TH ST STE 7
ERIE PA
16505-3380
US

IV. Provider business mailing address

PO BOX 9896
ERIE PA
16505-8896
US

V. Phone/Fax

Practice location:
  • Phone: 724-813-9693
  • 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
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRANDON WILEY
Title or Position: CHIEF EXECUTIVE DIRECTOR
Credential: LPC
Phone: 724-813-9693