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General NPI Number Information
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NPI Number | 1255255923
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Entity Type | Organization
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Legal Business Name | WILD MINDS COUNSELING LLC
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Dates
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Enumeration Date | 08/06/2026
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 105 E SHORE N
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City | GRAND ISLE
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State | VT
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Zip | 05458-2348
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Country | US
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Telephone | 802-234-1109
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Fax | 802-419-9557
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Provider Business Mailing Address
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Address Line | PO BOX 512
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City | SOUTH HERO
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State | VT
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Zip | 05486-0512
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Country | US
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Telephone | 802-234-1109
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Fax | 802-419-9557
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Authorized Official
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Title or Position | OWNER
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Name | VANESSA BLAIS O'SHEA
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Credential | LICSW
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Telephone | 802-234-1109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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