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MRS. LISA LANELLE WYLY ASW.
Clinical >> Social Worker >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1770610040
Individual Registrant:MRS. LISA LANELLE WYLY ASW.
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
14 SIERRA DRIVE KERNVILLE, CA 93238 US
Tel: 760-417-1932 Fax: 760-376-3034
Tel: 760-417-1932 Fax: 760-376-3034
Contact information for business:
P.O. BOX 363 WOFFORD HEIGHTS, CA 93285 US
Tel: 760-417-1932 Fax: 760-376-3034
Tel: 760-417-1932 Fax: 760-376-3034
Registration Information:
NPI: 1770610040
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 1041C0700X | Behavioral Health & Social Service Providers Social Worker Clinical | CA | ASW98599 |
| Y | 101YM0800X | Behavioral Health & Social Service Providers Counselor | CA | ASW98599 |
| N | 101YA0400X | Behavioral Health & Social Service Providers Counselor | CA | C8528805 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
