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Organization
WISEMIND SOBER LIVING AND TREATMENT, LLC
Active
Organization
WISEMIND SOBER LIVING AND TREATMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES DANIEL MCCREARY (CHIEF EXECUTIVE OFFICER)
(563) 265-7211
Entity
Organization
Contact information
Practice address
6234 W BEHREND DR APT 3105, GLENDALE, AZ 85308-6919
(480) 665-5311
Mailing address
5755 W IRMA LN, GLENDALE, AZ 85308-9178
(563) 265-7211
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
09/30/2020
Last updated
11/10/2020
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