Provider Demographics
NPI:1619636974
Name:WYLIE, CASEY (LMHC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:WYLIE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9957 MOORINGS DR STE 302
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2415
Mailing Address - Country:US
Mailing Address - Phone:888-793-2304
Mailing Address - Fax:888-793-2304
Practice Address - Street 1:9957 MOORINGS DR STE 302
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2415
Practice Address - Country:US
Practice Address - Phone:888-793-2304
Practice Address - Fax:888-793-2304
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health