MEDICARE: MCWISDOM COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1609720978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCWISDOM COUNSELING LLC

Provider Business Mailing Address
First Line	:	1401 N MCMILLAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-3048
Country	:	US
Telephone Number	:	405-824-5553
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 MAGNOLIA CT STE 119
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-1420
Country	:	US
Telephone Number	:	405-824-5553
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ASHLEY WISDOM
Credential	:	M.ED
Telephone Number	:	405-824-5553

Provider Enumeration Date	:	02/24/2026
Last Update Date	:	02/24/2026

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