Provider Demographics
NPI:1992047948
Name:WISE, KARLA KELPIN (LPCC)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:KELPIN
Last Name:WISE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:KELPIN
Other - Last Name:BOEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4105 VERA CRUZ AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1724
Mailing Address - Country:US
Mailing Address - Phone:763-546-1627
Mailing Address - Fax:
Practice Address - Street 1:4105 VERA CRUZ AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1724
Practice Address - Country:US
Practice Address - Phone:763-546-1627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health