Organization Name: | WYLIE COUNSELING ASSOCIATES, PLLC |
NPI Number: | 1205086295 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEVIN J BRUNER (DIRECTOR) |
Mailing Address: | 100 N 1st St Wylie |
State: | TX US |
Postal Code: | 750984473 |
Phone Number: | 4697574525 |
Fax Number: | 4697574525 |
NPI Enumeration Date: | 09/25/2008 |
NPI Last Update Date: | 04/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 62714 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |