Provider Demographics
NPI:1588133607
Name:WANDERING MIND LLC
Entity type:Organization
Organization Name:WANDERING MIND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MELENDEZ
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-887-6464
Mailing Address - Street 1:1214 1ST AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-4276
Mailing Address - Country:US
Mailing Address - Phone:706-566-2386
Mailing Address - Fax:706-887-6565
Practice Address - Street 1:1214 1ST AVE STE 270
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-4276
Practice Address - Country:US
Practice Address - Phone:706-566-2386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty