Individual
MR. TONY FERNANDO WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PASTOR
Contact information
Practice address
1201 NE 68TH ST, OKLAHOMA CITY, OK 73111-7817
(405) 639-7561
Mailing address
1201 NE 68TH ST, OKLAHOMA CITY, OK 73111-7817
(405) 639-7561
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/14/2013
Last updated
01/14/2013
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