Individual
CASEY LAYNE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1044 N NARCISSUS AVE, BROKEN ARROW, OK 74012-1468
(918) 505-8209
Mailing address
1044 N NARCISSUS AVE, BROKEN ARROW, OK 74012-1468
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
08/09/2017
Last updated
08/09/2017
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