Individual
JEANIA MARIE WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LPC, NCC
Contact information
Practice address
8911 E 92ND CT, TULSA, OK 74133-5614
(918) 853-1475
Mailing address
5310 E 31ST ST, TULSA, OK 74135-5012
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
10549
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
SELF-PAY
—
Enumeration date
11/14/2022
Last updated
04/07/2023
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