Ethan Wise, MA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

4201 Excelsior Blvd
St Louis Park, MN 55416-4728

Phone

(952) 933-8900

NPI assigned

Nov 11, 2025

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Ethan E. Wise Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Applied Care Services, Inc.

  • Community/Behavioral Health Agency
  • Richfield, MN
  • NPI 1932475647
  NPD (past)

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

{
    "created_epoch": "1762819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762819200000",
    "number": "1750251997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4105 VERA CRUZ AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554221724",
            "telephone_number": "612-444-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554164728",
            "telephone_number": "952-933-8900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6600 Lyndale Ave S Ste 110",
            "address_purpose": "LOCATION",
            "city": "Richfield",
            "state": "MN",
            "postal_code": "554233398",
            "country_code": "US",
            "telephone_number": "612-205-5332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISE",
        "first_name": "ETHAN",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-11-11",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ETHAN",
            "last_name": "WISE",
            "middle_name": "E.",
            "credential": "MA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Molly M Wingert
• Terence Wingert
• Holly Winters, PSYD LP
• Brittany E Wirth, DPT
• Afton Rose Wise, DPT
• Trisha R. Witmer, M.A. LMFT
• Patricia Ann Witt, RD
• Patti K Witt
• Sarah L. Witt, MED CCC-SLP
• Pamela J Witte, PT

• Mental Health Counselor in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2025; 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.