Individual
STACY ANNE WYLLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
540 ALBERT ST, MANDEVILLE, LA 70448-5402
(985) 373-6423
Mailing address
540 ALBERT ST, MANDEVILLE, LA 70448-5402
(985) 373-6423
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFT1581
LA
Other
Enumeration date
07/22/2019
Last updated
05/23/2025
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