Provider Demographics
NPI:1801460878
Name:WISE PRACTICE PLLC
Entity type:Organization
Organization Name:WISE PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:O'DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:248-891-6946
Mailing Address - Street 1:26669 SPICER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3853
Mailing Address - Country:US
Mailing Address - Phone:248-891-6946
Mailing Address - Fax:
Practice Address - Street 1:480 GRACE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5102
Practice Address - Country:US
Practice Address - Phone:248-891-6946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1447672191OtherNPI