Organization
WISEMAN GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK WAYNE WISEMAN LPC (OWNER)
(208) 919-9706
Entity
Organization
Contact information
Practice address
2422 12TH AVE RD, 144, NAMPA, ID 83686-6300
(208) 919-9706
Mailing address
2422 12TH AVE RD, 144, NAMPA, ID 83686-6300
(208) 919-9706
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
3034
ID
251S00000X
Community/Behavioral Health Agency
Primary
3034
ID
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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