IndividualActive
Ethan Wise, MA
NPI 1750251997 · Mental Health Counselor · St Louis Park, MN
Provider details
- NPI number
- 1750251997
- Entity type
- Individual
- Primary specialty
- Mental Health CounselorBehavioral Health & Social Service Providers
- Credential
- MA
- Sex
- Male
- Sole proprietor
- Yes
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Established profile(52/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
83% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4201 Excelsior Blvd
St Louis Park, MN 55416-4728
Phone: (952) 933-8900
Street-level locationGet directions
Mailing address
4105 Vera Cruz Ave N
Minneapolis, MN 55422-1724
Additional practice locations (1)
- 6600 Lyndale Ave S Ste 110Richfield, MN 55423-3398Phone: (612) 205-5332
Registry dates
- Enumerated
- 2025-11-11
- Last updated
- 2025-11-11
- Certified
- 2025-11-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.