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ETHAN WISE MA
NPI 1750251997
Counselor - Mental Health in St Louis Park, MN

Active since November 11, 2025
4201 EXCELSIOR BLVD, ST LOUIS PARK, MN 55416(952) 933-8900 Get Directions Write a Review

NPPES record last updated: November 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Ethan Wise Ma NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHAN WISE MA (NPI 1750251997) is an individual mental health provider in St Louis Park, Minnesota and active in the NPI registry since November 2025. He maintains a secondary practice location in Richfield.

NPPES Registry Identity

NPI1750251997
Entity TypeIndividualMale
Primary Taxonomy101YM0800X
Provider Legal NameETHAN WISECredential: MA
Location Address4201 EXCELSIOR BLVDSt Louis Park, MN 55416-4728
Mailing Address4105 Vera Cruz Ave NMinneapolis, MN 55422-1724 · (612) 444-1167
Phone(952) 933-8900
Sole ProprietorYes
Enumeration DateNovember 11, 2025
NPPES CertifiedNovember 11, 2025
✔ NPI 1750251997 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
4201 EXCELSIOR BLVD, St Louis Park, MN 55416
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Other Names 1

Professional Name (2)Ethan E. Wise Ma

Secondary Practice Location 1

Location 16600 Lyndale Ave S Ste 110Richfield, MN 55423-3398 · Phone (612) 205-5332

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RACHEL ANDERSON NP-C
Nurse Practitioner
4201 EXCELSIOR BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 933-8900
DR. JILL MAVEN GRAY PSYD, LP
Psychologist (Clinical)
4201 EXCELSIOR BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 933-8900
DR. TOAN QUOC TRAN D.P.T.
Physical Therapist
4201 EXCELSIOR BLVD
SAINT LOUIS PARK, MN 55416
Hennepin County (952) 933-8900
MINNESOTA MEDICAL AND REHABILITATIVE SERVICES, LLC
Physical Therapist
4201 EXCELSIOR BLVD
ST. LOUIS PARK, MN 55416
Hennepin County (952) 564-3880
DR. OLGA KARACHENETS M.D.
Family Medicine
4201 EXCELSIOR BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 933-8900
LINDA SHAW HALLER PA-C, MPH
Physician Assistant (Medical)
4201 EXCELSIOR BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 564-3880
HOMEOPATHIC MEDICAL CLINIC
Clinic/Center (Health Service)
4201 EXCELSIOR BLVD
MINNEAPOLIS, MN 55416
Hennepin County (952) 933-8900
TARAN JOHN BARRETT DC
Chiropractor
4201 EXCELSIOR BLVD
ST LOUIS PARK, MN 55416
Hennepin County (952) 933-8900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Wise's NPI number?

The NPI number for Ethan Wise is 1750251997. It was assigned to this individual provider in the NPPES registry on November 11, 2025. The provider is also known as Ethan E. Wise Ma.

Where is Ethan Wise located?

Ethan Wise practices at 4201 Excelsior Blvd, St Louis Park, MN 55416. The listed phone number is (952) 933-8900.

What is Ethan Wise's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Ethan Wise was last updated on November 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.