Healthcare Provider Details

I. General information

NPI: 1942780432
Provider Name (Legal Business Name): HEALTHYMINDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 LANDMARK PL STE 210
MADISON WI
53713-4200
US

IV. Provider business mailing address

2909 LANDMARK PL STE 210
MADISON WI
53713-4200
US

V. Phone/Fax

Practice location:
  • Phone: 608-239-8807
  • Fax:
Mailing address:
  • Phone: 608-239-8807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number834-124
License Number State

VIII. Authorized Official

Name: ANDREW DAVID PETERSON
Title or Position: PRESIDENT AND CHIEF EXECUTIVE OFFIC
Credential: MS, LMFT
Phone: 608-239-8807