Provider Demographics
NPI:1457318594
Name:WISE, KATIE ANNE (MED,LPCC,)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ANNE
Last Name:WISE
Suffix:
Gender:F
Credentials:MED,LPCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 KEENELAND TRL
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8544
Mailing Address - Country:US
Mailing Address - Phone:937-869-2932
Mailing Address - Fax:
Practice Address - Street 1:US 1909
Practice Address - Street 2:US 1909
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-4090
Practice Address - Country:US
Practice Address - Phone:606-546-3805
Practice Address - Fax:606-546-3903
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103975101YP2500X
101YM0800X, 101YM0800X
KYKY-1579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional