MEDICARE: WISDOM TREATMENT, LLC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1881131696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISDOM TREATMENT, LLC

Provider Business Mailing Address
First Line	:	3031 N SAN FERNANDO BLVD STE 100
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-4704
Country	:	US
Telephone Number	:	424-208-9829
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 N SAN FERNANDO BLVD STE 100
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-4704
Country	:	US
Telephone Number	:	424-208-9829
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AARON BARSALOU
Credential	:
Telephone Number	:	832-312-9611

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	01/31/2017

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Directions to “WISDOM TREATMENT, LLC ” Practice Location

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