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NPI Code Detail

MEDICARE: MARYANN WIESE LPCC-S

MEDICARE: MARYANN WIESE LPCC-S
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831606631
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYANN WIESE LPCC-S
Provider Business Mailing Address
First Line : 2823 FRANKFORT AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-2639
Country : US
Telephone Number : 502-893-0241
Fax Number : 502-896-2394
Provider Business Practice Location Address
First Line : 2823 FRANKFORT AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40206-2639
Country : US
Telephone Number : 502-893-0241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2018
Last Update Date : 01/23/2026

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Directions to “ MARYANN WIESE LPCC-S” Practice Location

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