Individual
ROBERT WISDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMLP, LCP
Contact information
Practice address
1558 HAYES DR, MANHATTAN, KS 66502-5068
(785) 587-4315
(785) 587-4339
Mailing address
PO BOX 747, MANHATTAN, KS 66505-0747
(785) 587-4300
(785) 587-4377
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0157
KS
101YA0400X
Addiction (Substance Use Disorder) Counselor
130
KS
101YP2500X
Professional Counselor
Primary
1438
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11654652
CAQH
—
05
—
200441350A
—
KS
01
—
856662
BCBS
KS
Enumeration date
06/15/2006
Last updated
01/24/2013
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