Provider Demographics
NPI:1477565869
Name:WISE, CLAIRE Y (MFT)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:Y
Last Name:WISE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 HOLIDAY CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0027
Mailing Address - Country:US
Mailing Address - Phone:858-455-5583
Mailing Address - Fax:858-623-3253
Practice Address - Street 1:3252 HOLIDAY CT
Practice Address - Street 2:SUITE 201
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0027
Practice Address - Country:US
Practice Address - Phone:858-455-5583
Practice Address - Fax:858-623-3253
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT24280101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health