Provider Demographics
NPI:1356963813
Name:WISE, KADY MAXWELL (LPC-)
Entity type:Individual
Prefix:
First Name:KADY
Middle Name:MAXWELL
Last Name:WISE
Suffix:
Gender:F
Credentials:LPC-
Other - Prefix:
Other - First Name:KADY
Other - Middle Name:
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:218 HUNTERS CIR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7473
Mailing Address - Country:US
Mailing Address - Phone:903-241-6608
Mailing Address - Fax:
Practice Address - Street 1:2520 LONGVIEW ST STE 307
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4202
Practice Address - Country:US
Practice Address - Phone:512-607-9360
Practice Address - Fax:877-775-9422
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83704101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health