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General NPI Number Information
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NPI Number | 1871775494
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Entity Type | Individual
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Provider Name | STEPHEN WISE LCPC, LPCC, LMHC
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Gender | Male
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 288 MARTIN ST STE 100
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City | BLAINE
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State | WA
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Zip | 98230-4045
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Country | US
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Telephone | 360-594-0767
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Fax | 888-972-9442
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | BLAINE
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State | WA
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Zip | 98231-0069
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Country | US
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Telephone | 425-321-1242
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Fax | 888-972-9442
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.007858
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC11238
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60959703
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License Number State | WA
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