Individual
JERRY THOMAS WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, MS
Contact information
Practice address
703 PRO-MED LN STE 102, CARMEL, IN 46032-5318
(317) 919-6264
Mailing address
703 PRO-MED LN STE 102, CARMEL, IN 46032-5318
(317) 919-6264
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
11/23/2009
Last updated
11/23/2009
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