Provider Demographics
NPI:1811240690
Name:WISE CHOICES, INC
Entity type:Organization
Organization Name:WISE CHOICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:260-482-2586
Mailing Address - Street 1:205 E WASHINGTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-4404
Mailing Address - Country:US
Mailing Address - Phone:260-482-2586
Mailing Address - Fax:260-471-5949
Practice Address - Street 1:205 E WASHINGTON CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-4404
Practice Address - Country:US
Practice Address - Phone:260-482-2586
Practice Address - Fax:260-471-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000653A106H00000X, 101Y00000X
IN33000819A101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty