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NPI Code Detail

MEDICARE: BRANDON LAMAR WILEY LAC

MEDICARE: BRANDON LAMAR WILEY LAC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorA2208027AR
2101YP2500XProfessional CounselorP2406001AR

General Provider Information

NPI Number : 1700326279
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON LAMAR WILEY LAC
Provider Business Mailing Address
First Line : 2809 FOREST HOME RD
Second Line :
City : JONESBORO
State : AR
Zip : 72401-5320
Country : US
Telephone Number : 866-972-1268
Fax Number :
Provider Business Practice Location Address
First Line : 814 HIGDON FERRY RD
Second Line :
City : HOT SPRINGS
State : AR
Zip : 71913-6128
Country : US
Telephone Number : 501-623-6000
Fax Number : 501-623-6004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2017
Last Update Date : 06/05/2024

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Directions to “ BRANDON LAMAR WILEY LAC” Practice Location

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