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Organization
WYLIE CENTER
Active
Organization
WYLIE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAMANTHA G. LILLO LCSW (SUPERVISOR)
(951) 683-5193
Entity
Organization
Contact information
Practice address
22964 PABLO, NUEVO, CA 92567-9635
(909) 286-2184
Mailing address
22964 PABLO, NUEVO, CA 92567-9635
(909) 286-2184
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
25834
CA
Other
Enumeration date
10/01/2009
Last updated
10/01/2009
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