MEDICARE: MS. ROBIN LYNN WILEY LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0070961	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NM100416	OTHER	NM	VALUEOPTIONS

General Provider Information

NPI Number	:	1447336441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBIN LYNN WILEY LPCC

Provider Business Mailing Address
First Line	:	PO BOX 22267
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87502
Country	:	US
Telephone Number	:	505-920-6554
Fax Number	:	505-473-1297

Provider Business Practice Location Address
First Line	:	3012 CIELO CT STE C
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-5088
Country	:	US
Telephone Number	:	505-920-6554
Fax Number	:	505-473-1297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/08/2007

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