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General NPI Number Information
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NPI Number | 1164844197
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Entity Type | Organization
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Legal Business Name | 08WISDOM PROFESSIONAL COUNSELING, PLLC
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 6309 PRESTON ROAD SUITE 1200
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City | PLANO
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State | TX
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Zip | 75024-2741
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Country | US
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Telephone | 214-212-3008
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Fax | 972-526-7903
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Provider Business Mailing Address
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Address Line | 6309 PRESTON ROAD SUITE 1200
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City | PLANO
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State | TX
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Zip | 75024-2741
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Country | US
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Telephone | 214-212-3008
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Fax | 972-526-7903
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DEAN EDWARD WISDOM
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Credential | LPC
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Telephone | 214-212-3008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 64675
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License Number State | TX
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