Healthcare Provider Details

I. General information

NPI: 1427833995
Provider Name (Legal Business Name): KAILA WYLIE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 INTERNATIONAL DR
PORTSMOUTH NH
03801-6833
US

IV. Provider business mailing address

31 RICHARDSON DR
DOVER NH
03820-4318
US

V. Phone/Fax

Practice location:
  • Phone: 603-957-1877
  • Fax:
Mailing address:
  • Phone: 760-445-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: