Healthcare Provider Details

I. General information

NPI: 1811240690
Provider Name (Legal Business Name): WISE CHOICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E WASHINGTON CENTER RD
FORT WAYNE IN
46825-4404
US

IV. Provider business mailing address

205 E WASHINGTON CENTER RD
FORT WAYNE IN
46825-4404
US

V. Phone/Fax

Practice location:
  • Phone: 260-482-2586
  • Fax: 260-471-5949
Mailing address:
  • Phone: 260-482-2586
  • Fax: 260-471-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number35000653A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number33000819A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33000819A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35000653A
License Number StateIN

VIII. Authorized Official

Name: MARGUERITE KAY WISE
Title or Position: OWNER
Credential: MS
Phone: 260-482-2586