Healthcare Provider Details

I. General information

NPI: 1144567579
Provider Name (Legal Business Name): DONNA MARIE WYSE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W MAUMEE ST STE A
ANGOLA IN
46703-1346
US

IV. Provider business mailing address

10377 STATE ROUTE 191
WEST UNITY OH
43570-9506
US

V. Phone/Fax

Practice location:
  • Phone: 260-665-6543
  • Fax: 260-665-6535
Mailing address:
  • Phone: 419-553-0832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003616A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC1100131
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0600429
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: