| Doctor Name: | MR. WELTON MIGUEL WILEY |
| NPI Number: | 1154469559 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LAC, CCS |
| License Number: | LAC 880 |
| Business Practice Address: | 602 E Georgia Ave Ruston, LA - 712703931 |
| Business Phone Number: | 3182514125 |
| Business Fax Number: | 3182515000 |
| Mailing Address: | 189 Oscar Rd, WEST MONROE |
| State: | LA |
| Postal Code: | 712921298 |
| Phone Number: | 3183964904 |
| Fax Number: | 3183623268 |
| NPI Enumeration Date: | 02/01/2007 |
| NPI Last Update Date: | 12/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LAC 880 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |