Individual
CHRISTIAN LLOYD SAMUEL WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 N BROAD ST STE 200, MANKATO, MN 56001-3569
(507) 225-1500
Mailing address
216 JOSEPH PATH, MANKATO, MN 56001-5298
(713) 503-0123
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
07/16/2024
Last updated
07/16/2024
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