Organization
WISE CCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY JOANN ROSS M.A., LPC-S (EXECUTIVE DIRECTOR)
(940) 627-1618
Entity
Organization
Contact information
Practice address
1650 S FM 51 STE 400, DECATUR, TX 76234-3630
(940) 627-1618
(940) 393-0429
Mailing address
1650 S FM 51 STE 400, DECATUR, TX 76234-3630
(940) 627-1618
(940) 393-0429
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
03/14/2022
Last updated
03/14/2022
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