Healthcare Provider Details

I. General information

NPI: 1255255923
Provider Name (Legal Business Name): WILD MINDS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E SHORE N
GRAND ISLE VT
05458-2348
US

IV. Provider business mailing address

PO BOX 512
SOUTH HERO VT
05486-0512
US

V. Phone/Fax

Practice location:
  • Phone: 802-234-1109
  • Fax: 802-419-9557
Mailing address:
  • Phone: 802-234-1109
  • Fax: 802-419-9557

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: VANESSA BLAIS O'SHEA
Title or Position: OWNER
Credential: LICSW
Phone: 802-234-1109