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General NPI Number Information
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NPI Number | 1780116822
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Entity Type | Organization
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Legal Business Name | WISE MINDS COUNSELING, LLC
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 1150 N 12TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32501-3308
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Country | US
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Telephone | 850-602-2411
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Fax | 850-469-1081
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Provider Business Mailing Address
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Address Line | 1150 N 12TH AVE
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City | PENSACOLA
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State | FL
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Zip | 32501-3308
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Country | US
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Telephone | 850-602-2411
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Fax | 850-469-1081
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | KELCEY KILLINGSWORTH
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Credential | PHD, LMHC, NCC
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Telephone | 850-602-2411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 10486
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License Number State | FL
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