Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1265039119 |
---|---|
Provider Name | Arthur Joe Wylie IV |
First Address | Quincy, CA 95971-9120 |
Second Address | Richvale, CA 95974-9597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2020 |
Last Update Date | 05/10/2020 |