Provider Demographics
NPI:1184478802
Name:MINDWISE THERAPY AND MENTAL HEALTH CONSULTATION LLC
Entity type:Organization
Organization Name:MINDWISE THERAPY AND MENTAL HEALTH CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSW
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTN
Authorized Official - Middle Name:
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:513-479-1182
Mailing Address - Street 1:3268 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2220
Mailing Address - Country:US
Mailing Address - Phone:513-479-1182
Mailing Address - Fax:
Practice Address - Street 1:3268 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2220
Practice Address - Country:US
Practice Address - Phone:513-479-1182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-17
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty