Healthcare Provider Details

I. General information

NPI: 1942111265
Provider Name (Legal Business Name): WISEHEART INTEGRATIVE THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 TROY DR
MADISON WI
53704-1575
US

IV. Provider business mailing address

6580 MONONA DR # 1247
MONONA WI
53716-4032
US

V. Phone/Fax

Practice location:
  • Phone: 608-335-6480
  • Fax:
Mailing address:
  • Phone: 608-335-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. DONAL GRANT MACCOON
Title or Position: SOLE PROPRIETER
Credential: PHD
Phone: 608-335-6480