Provider Demographics
NPI:1316093677
Name:WISE, KAREN ILENE (MS, LPC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ILENE
Last Name:WISE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:925 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2766
Mailing Address - Country:US
Mailing Address - Phone:720-231-2459
Mailing Address - Fax:303-733-8586
Practice Address - Street 1:925 LINCOLN ST.
Practice Address - Street 2:SUITE 100 C/O MDDS
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2736
Practice Address - Country:US
Practice Address - Phone:720-231-2459
Practice Address - Fax:303-488-0177
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2650101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health