Individual provider · Type 1 NPI

Mark Wyly

Mental Health Counselor · Diamond Springs, CA

NPI number 1093065617 Active

Practice location

768 Pleasant Valley Rd, Ste. 304
Diamond Springs, CA 95619-9260

Call (530) 621-9800 Map

Mailing address

1202 School St
Folsom, CA 95630-3309

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1093065617

Mark Wyly's National Provider Identifier is 1093065617, issued on Sep 11, 2012. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Diamond Springs, CA. The record was last updated on Sep 11, 2012.