| Doctor Name: | ROBERT WISDOM |
| NPI Number: | 1063456721 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMLP, LCP |
| License Number: | 0157 |
| Business Practice Address: | 1558 Hayes Dr Manhattan, KS - 665025068 |
| Business Phone Number: | 7855874315 |
| Business Fax Number: | 7855874339 |
| Mailing Address: | Po Box 747, MANHATTAN |
| State: | KS |
| Postal Code: | 665050747 |
| Phone Number: | 7855874300 |
| Fax Number: | 7855874377 |
| NPI Enumeration Date: | 06/15/2006 |
| NPI Last Update Date: | 01/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 0157 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KS |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |