Provider Demographics
NPI:1316318694
Name:WISHARD, ALAN (MA LPC)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:WISHARD
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 KENT DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3305
Mailing Address - Country:US
Mailing Address - Phone:405-226-8548
Mailing Address - Fax:405-285-4767
Practice Address - Street 1:307 E DANFORTH RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4483
Practice Address - Country:US
Practice Address - Phone:405-285-4700
Practice Address - Fax:405-285-4767
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional