Provider Demographics
NPI:1154355535
Name:WISE, JOHN FLINT (LMSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FLINT
Last Name:WISE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 COUNTY ROAD 1389
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-4100
Mailing Address - Country:US
Mailing Address - Phone:405-224-5898
Mailing Address - Fax:
Practice Address - Street 1:1170 COUNTY ROAD 1389
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-4100
Practice Address - Country:US
Practice Address - Phone:405-224-5898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker