Healthcare Provider Details

I. General information

NPI: 1851524821
Provider Name (Legal Business Name): JOSHUA GORDON WYLIE MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2282 UNION ST
SAN FRANCISCO CA
94123-3902
US

IV. Provider business mailing address

2282 UNION ST
SAN FRANCISCO CA
94123-3902
US

V. Phone/Fax

Practice location:
  • Phone: 415-747-4563
  • Fax:
Mailing address:
  • Phone: 415-747-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: