| Doctor Name: | MRS. LISA LANELLE WYLY |
| NPI Number: | 1770610040 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CADC II |
| License Number: | C8528805 |
| Business Practice Address: | 2731 Nugget Ave Lake Isabella, CA - 93240 |
| Business Phone Number: | 7603793412 |
| Business Fax Number: | 7603795332 |
| Mailing Address: | 6625 Laurel Avenue, Po Box 568 LAKE ISABELLA |
| State: | CA |
| Postal Code: | 93204 |
| Phone Number: | 7603793412 |
| Fax Number: | 7603795332 |
| NPI Enumeration Date: | 02/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | C8528805 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |