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General NPI Number Information
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NPI Number | 1184794620
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Entity Type | Individual
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Provider Name | EARNEST JEFFERY WILES PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 9845 HORN ROAD SUITE 190
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City | SACRAMENTO
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State | CA
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Zip | 95827-2563
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Country | US
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Telephone | 916-329-8555
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Fax | 916-476-4193
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Provider Business Mailing Address
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Address Line | 9845 HORN ROAD SUITE 190
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City | SACRAMENTO
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State | CA
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Zip | 95827-2563
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Country | US
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Telephone | 916-329-8555
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Fax | 916-476-4193
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC302
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License Number State | CA
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