Healthcare Provider Details

I. General information

NPI: 1467059311
Provider Name (Legal Business Name): ARTHUR WYLIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 BROADWAY ST
RICHVALE CA
95974-9597
US

IV. Provider business mailing address

455 MAIN ST
QUINCY CA
95971-9120
US

V. Phone/Fax

Practice location:
  • Phone: 530-882-4125
  • Fax:
Mailing address:
  • Phone: 530-882-4125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: