Provider Demographics
NPI:1851152383
Name:WISE MIND TX
Entity type:Organization
Organization Name:WISE MIND TX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-366-1488
Mailing Address - Street 1:4904 TRIMMIER RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-3821
Mailing Address - Country:US
Mailing Address - Phone:254-236-3364
Mailing Address - Fax:254-488-3038
Practice Address - Street 1:4904 TRIMMIER RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3821
Practice Address - Country:US
Practice Address - Phone:254-236-3364
Practice Address - Fax:254-488-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty