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General NPI Number Information
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NPI Number | 1982582698
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Entity Type | Organization
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Legal Business Name | WISE & WELL LLC
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Dates
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Enumeration Date | 08/22/2025
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | 146 E MAIN ST
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City | MANCHESTER
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State | MI
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Zip | 48158-8748
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Country | US
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Telephone | 734-386-0633
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 96
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City | MANCHESTER
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State | MI
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Zip | 48158-0096
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | KATHERINE MCCLURE
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Credential | LMSW
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Telephone | 734-707-6763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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