MEDICARE: MRS. EMILY NICOLE WISE M.ED., 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	101YP2500X	Professional Counselor	5665	OK

General Provider Information

NPI Number	:	1386943520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY NICOLE WISE M.ED., LPC

Provider Business Mailing Address
First Line	:	13637 SE 94TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165-4633
Country	:	US
Telephone Number	:	405-821-6447
Fax Number	:

Provider Business Practice Location Address
First Line	:	13637 SE 94TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165-4633
Country	:	US
Telephone Number	:	405-821-6447
Fax Number	:

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

Provider Enumeration Date	:	03/25/2011
Last Update Date	:	02/29/2016

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