Provider Demographics
NPI:1366873564
Name:WISDOM, DEAN EDWARD (LPC, RPT)
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:EDWARD
Last Name:WISDOM
Suffix:
Gender:M
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 PRESTON ROAD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2741
Mailing Address - Country:US
Mailing Address - Phone:214-212-3008
Mailing Address - Fax:972-526-7903
Practice Address - Street 1:6309 PRESTON ROAD
Practice Address - Street 2:SUITE 1200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2741
Practice Address - Country:US
Practice Address - Phone:214-212-3008
Practice Address - Fax:972-526-7903
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64675101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional