Mackenzie Wise

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C.2405463-TRNE Issued in OH

Practice address

3171 Beaver Vu Dr Ste C
Beavercreek, OH 45434-6368

Phone

(937) 306-8077

Fax

(937) 306-8079

NPI assigned

Jan 17, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1407617467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3171 BEAVER VU DR STE C",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454346368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3171 BEAVER VU DR STE C",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454346368",
            "telephone_number": "937-306-8077",
            "fax_number": "937-306-8079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "MACKENZIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-17",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "C.2405463-TRNE",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "C.2405463-TRNE",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sunishka M Wimalawansa, M.D., M.B.A.
• Tara Winebold, MD
• Lapearl Logan Winfrey, PH.D
• Wings of Love Services
• Beverly Ann Wirth, R.N.
• Sarah Wiswell, PT, DPT
• Michael Anthony Witt, MD
• Scarlett Lindsay Wolfinbarger, CNP
• Bradley Wolodkiewicz, PHARM.D
• Emma Louise Wood, LSW

• Mental Health Counselor in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.