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General NPI Number Information
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NPI Number | 1023791258
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Entity Type | Organization
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Legal Business Name | WISE MIND BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 12/28/2025
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Provider Practice Location Address
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Address Line | 176 THOMAS JOHNSON DR STE 204
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City | FREDERICK
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State | MD
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Zip | 21702-4538
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Country | US
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Telephone | 240-608-2307
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Fax |
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Provider Business Mailing Address
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Address Line | 176 THOMAS JOHNSON DR
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City | FREDERICK
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State | MD
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Zip | 21702-4410
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Country | US
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Telephone | 240-608-2307
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW GOODWIN
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Credential | LCPC
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Telephone | 240-608-2307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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