MEDICARE: CHRISTINA WILEY MED LPC-S

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	4851	LA
2	101YM0800X	Mental Health Counselor		LA
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1558735662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA WILEY MED LPC-S

Provider Business Mailing Address
First Line	:	1117 MARION HWY
Second Line	:
City	:	FARMERVILLE
State	:	LA
Zip	:	71241-9313
Country	:	US
Telephone Number	:	318-503-8682
Fax Number	:	318-982-8103

Provider Business Practice Location Address
First Line	:	4008 CALIFORNIA LN
Second Line	:
City	:	OAK RIDGE
State	:	LA
Zip	:	71264-9331
Country	:	US
Telephone Number	:	318-732-8023
Fax Number	:	318-605-4133

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/24/2025

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Directions to “ CHRISTINA WILEY MED LPC-S” Practice Location

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