MEDICARE: JOSEPH WILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	171M00000X	Case Manager/Care Coordinator
3	251S00000X	Community/Behavioral Health Agency
4	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000000	OTHER		NO SPECIFIED

General Provider Information

NPI Number	:	1699053561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH WILEY

Provider Business Mailing Address
First Line	:	911 N BUFFALO DR UNIT 213
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0381
Country	:	US
Telephone Number	:	702-405-8088
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 N BUFFALO DR UNIT 213
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0381
Country	:	US
Telephone Number	:	702-405-8088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	05/05/2024

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Directions to “ JOSEPH WILEY ” Practice Location

Language	Start Address	Practice Location

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