Provider Demographics
NPI:1609394139
Name:WISE OLD OWL THERAPY, PLLC
Entity Type:Organization
Organization Name:WISE OLD OWL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:VIOLA
Authorized Official - Last Name:CURD
Authorized Official - Suffix:
Authorized Official - Credentials:MAT/MAC/NCC
Authorized Official - Phone:810-360-7000
Mailing Address - Street 1:11135 DAWN DR
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-9296
Mailing Address - Country:US
Mailing Address - Phone:810-360-7000
Mailing Address - Fax:
Practice Address - Street 1:11135 DAWN DR
Practice Address - Street 2:
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-9296
Practice Address - Country:US
Practice Address - Phone:810-360-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016102251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health