MEDICARE: MARK WAYNE WISEMAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	3034	ID

General Provider Information

NPI Number	:	1376847269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK WAYNE WISEMAN LPC

Provider Business Mailing Address
First Line	:	2422 12TH AVE RD
Second Line	:	NUMBER 144
City	:	NAMPA
State	:	ID
Zip	:	83686-6300
Country	:	US
Telephone Number	:	208-919-9706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2422 12TH AVE RD
Second Line	:	NUMBER 144
City	:	NAMPA
State	:	ID
Zip	:	83686-6300
Country	:	US
Telephone Number	:	208-919-9706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2011
Last Update Date	:	01/06/2011

Similar Medicare Providers

1548196587 — PICK PT NAMPA PHYSICAL THERAPY
Practice Location Address:

2422 12TH AVE RD
NAMPA, ID
83686-6300

Practice Phone: 208-466-0566
Practice Fax: 208-697-5213

1417181140 — DR. ANDREA MARLENE ALVAREZ PHARM D
Practice Location Address:

2400 12TH AVE RD
NAMPA, ID
83686-6300

Practice Phone: 208-463-2903
Practice Fax: 208-468-0215

1154615243 — LEGACY CHARTER SCHOOL
Practice Location Address:

2422 12TH AVE RD , #225
NAMPA, ID
83686-6300

Practice Phone: 208-466-7952
Practice Fax:

1245526771 — BRIAN J CHRISTIANSEN PHARM.D.
Practice Location Address:

2400 12TH AVE RD
NAMPA, ID
83686-6300

Practice Phone: 208-463-2903
Practice Fax:

1366720948 — MR. CHRISTOPHER KOLODY PHARM.D.
Practice Location Address:

2400 12TH AVE RD
NAMPA, ID
83686-6300

Practice Phone: 208-463-2903
Practice Fax: 208-468-0215

1255691622 — RODNEY RAY BRYANT RPH
Practice Location Address:

2400 12TH AVE RD
NAMPA, ID
83686-6300

Practice Phone: 208-463-2903
Practice Fax: 208-468-0215

Directions to “ MARK WAYNE WISEMAN LPC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.