Healthcare Provider Details

I. General information

NPI: 1619012473
Provider Name (Legal Business Name): KATHRYN MARGARET WYLER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 CAROL LN STE 280
LAFAYETTE CA
94549-4759
US

IV. Provider business mailing address

1080 CAROL LN STE 280
LAFAYETTE CA
94549-4759
US

V. Phone/Fax

Practice location:
  • Phone: 925-286-2895
  • Fax: 925-247-5493
Mailing address:
  • Phone: 925-286-2895
  • Fax: 925-247-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number46628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: