Provider Demographics
NPI:1578617312
Name:WISE, CLAUDIA COTHRAN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:COTHRAN
Last Name:WISE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 LAKEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7633
Mailing Address - Country:US
Mailing Address - Phone:407-376-4109
Mailing Address - Fax:407-382-9937
Practice Address - Street 1:315 N LAKEMONT AVE STE B
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3205
Practice Address - Country:US
Practice Address - Phone:407-830-6412
Practice Address - Fax:407-830-8413
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7591101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health