Healthcare Provider Details

I. General information

NPI: 1154587053
Provider Name (Legal Business Name): TOI LYNN WYLE MS, MFT, ERYT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 N CLAREMONT ST
SAN MATEO CA
94401-1924
US

IV. Provider business mailing address

101 MC LELLAN DR #1051
SOUTH SAN FRANCISCO CA
94080-7520
US

V. Phone/Fax

Practice location:
  • Phone: 415-235-5481
  • Fax: 650-877-8071
Mailing address:
  • Phone: 650-877-8071
  • Fax: 650-877-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC33428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: