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General NPI Number Information
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NPI Number | 1538786793
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Entity Type | Individual
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Provider Name | SHELBY LAUREL WYLLIE LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 14500 ROSCOE BLVD STE 400
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City | PANORAMA CITY
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State | CA
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Zip | 91402-4194
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Country | US
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Telephone | 213-807-2337
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Fax |
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Provider Business Mailing Address
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Address Line | 23055 SHERMAN WAY # 4364
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City | WEST HILLS
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State | CA
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Zip | 91307-2000
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Country | US
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Telephone | 818-585-1240
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 113830
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License Number State | CA
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