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Individual
KELLY DIANE WYLIE
Active
Individual
KELLY DIANE WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17461
TX
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
64298
TX
Other
Enumeration date
09/13/2023
Last updated
08/25/2026
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