Provider Demographics
NPI:1346087756
Name:WISE SOUL LLC
Entity type:Organization
Organization Name:WISE SOUL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LEAD CONSULTANT/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, MSW, PPSC, ASW
Authorized Official - Phone:559-759-2790
Mailing Address - Street 1:6405 E BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5709
Mailing Address - Country:US
Mailing Address - Phone:559-759-2790
Mailing Address - Fax:
Practice Address - Street 1:6405 E BUTLER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-5709
Practice Address - Country:US
Practice Address - Phone:559-759-2790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health