Healthcare Provider Details

I. General information

NPI: 1144961640
Provider Name (Legal Business Name): WISE MIND ACADEMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N MONROE ST STE 356
SPOKANE WA
99201-2158
US

IV. Provider business mailing address

5428 S REGAL ST UNIT 30208
SPOKANE WA
99223-8042
US

V. Phone/Fax

Practice location:
  • Phone: 509-542-7026
  • Fax:
Mailing address:
  • Phone: 509-505-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS LORI OBBIE
Title or Position: CO-OWNER
Credential: LMHC
Phone: 509-505-0655