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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