Individual provider · Type 1 NPI

Kelly Diane Wylie, LCDC

Addiction (Substance Use Disorder) Counselor · Bandera, TX

NPI number 1801673769 Active

Practice location

756 Purple Sage Rd
Bandera, TX 78003-3981

Mailing address

PO Box 69
Medina, TX 78055-0069

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X17461 (TX)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1801673769

Kelly Diane Wylie, LCDC's National Provider Identifier is 1801673769, issued on Sep 13, 2023. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Bandera, TX. The record was last updated on Aug 25, 2026.