Individual
KELLY LYNN WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5929 N MAY AVE, STE 302 BOX 37, OKLAHOMA CITY, OK 73112-3909
(405) 842-0500
(405) 842-0505
Mailing address
5929 N MAY AVE, STE 302 BOX 37, OKLAHOMA CITY, OK 73112-3909
(405) 842-0500
(405) 842-0505
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200077440A
—
OK
Enumeration date
01/03/2012
Last updated
04/17/2014
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