Provider Demographics
NPI:1457006835
Name:WILEY, GAYLE ALETHA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:GAYLE
Middle Name:ALETHA
Last Name:WILEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31435 COUNTY ROUTE 4
Mailing Address - Street 2:
Mailing Address - City:CAPE VINCENT
Mailing Address - State:NY
Mailing Address - Zip Code:13618-2177
Mailing Address - Country:US
Mailing Address - Phone:315-783-6004
Mailing Address - Fax:
Practice Address - Street 1:31435 COUNTY ROUTE 4
Practice Address - Street 2:
Practice Address - City:CAPE VINCENT
Practice Address - State:NY
Practice Address - Zip Code:13618-2177
Practice Address - Country:US
Practice Address - Phone:315-783-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health