Healthcare Provider Details

I. General information

NPI: 1982809521
Provider Name (Legal Business Name): STEPHANIE DAWN MCGUIRE WISE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S CHURCH ST
BOWLING GREEN OH
43402-2816
US

IV. Provider business mailing address

2005 ASHLAND AVE
TOLEDO OH
43620-1703
US

V. Phone/Fax

Practice location:
  • Phone: 419-373-6560
  • Fax:
Mailing address:
  • Phone: 419-841-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE-0003039
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberE-0003039
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: