Louise Wise LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

LOUISE WISE LLC

Doing business as

Georgia Behavioral Health Practitioner Clinic

Practice address

2206 Hanfred LN Ste 103
Tucker, GA 30084-4809

Phone

(678) 831-6429

Fax

(687) 668-2848

NPI assigned

Jan 26, 2019

Last updated

Apr 9, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Louise WiseNPI 1851782965

Title

Provider

Phone

(678) 831-6429

Specialties & licenses 1

Addresses

Other names 1

• Georgia Behavioral Health Practitioner Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Louise Wise, DNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tucker, GA
  • NPI 1851782965
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1548460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680998400000",
    "number": "1699239475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 309",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "300210309",
            "telephone_number": "678-368-5561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2206 HANFRED LN STE 103",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844809",
            "telephone_number": "678-831-6429",
            "fax_number": "687-668-2848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUISE WISE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-26",
        "last_updated": "2023-04-09",
        "certification_date": "2023-04-09",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "LOUISE",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "678-831-6429"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgia Behavioral Health Practitioner Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Georgia Behavioral Health Practitioner Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Live Well Home Care, LLC
• Ethel London, LPC
• Carla L. Long, SLP
• Natalie Long, MS
• Alvaro J Lopez, M.D.
• Alexandra Lucas
• Luxottica of America Inc (For Eyes (Cm220))
• Sean Lyons, DC
• Yovanna Madhere
• Priscilla Madu, RPN

• Mental Health Clinic/Center (Including Community Mental Health Center) in Tucker, GA
• Providers in Tucker, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.