Healthcare Provider Details

I. General information

NPI: 1447336441
Provider Name (Legal Business Name): ROBIN LYNN WILEY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 CIELO CT STE C
SANTA FE NM
87507-5088
US

IV. Provider business mailing address

PO BOX 22267
SANTA FE NM
87502
US

V. Phone/Fax

Practice location:
  • Phone: 505-920-6554
  • Fax: 505-473-1297
Mailing address:
  • Phone: 505-920-6554
  • Fax: 505-473-1297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0070961
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: