Active NPI
Jon Mark Wise
- Marriage & Family Therapist
- San Luis Obispo, CA
National Provider Identifier
1598263816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 103655
- Practice address
- 1411 Marsh St Ste 108
San Luis Obispo, CA 93401-2967 - Phone
- (805) 215-6317
- NPI assigned
- Feb 1, 2018
- Last updated
- Feb 1, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 103655 | CA | Primary |
Addresses
Primary practice location
1411 Marsh St Ste 108
San Luis Obispo, CA 93401-2967
Mailing address
2057 Bush Dr
Los Osos, CA 93402-3220
Phone (805) 215-6317
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 103655 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517443200000",
"number": "1598263816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2057 BUSH DR",
"city": "LOS OSOS",
"state": "CA",
"postal_code": "934023220",
"telephone_number": "805-215-6317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 MARSH ST STE 108",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934012967",
"telephone_number": "805-215-6317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "JON",
"middle_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-01",
"last_updated": "2018-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "103655",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
- Tanya Winje, AMFT 148628
- Julianna Grace Winninghoff, PT
- William Winston, BC-HIS
- Nichole Marie Winters
- Bettina L Wise
- Wogu & Wogu Neurosurgical and Spine Services Inc
- Elijah Uzoma Wogu, DO
- Anthony Michael Wolfe, MD
- Paul J Wolfrom, DO
- Womens Healthcare Specialists of San Luis Obispo Inc (Womens Healthcare Specialists Medical Group Inc)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.