Provider Demographics
NPI:1699369207
Name:ABUYA, WYCLIFFE
Entity Type:Individual
Prefix:MR
First Name:WYCLIFFE
Middle Name:
Last Name:ABUYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5082 BREEZEFIELD DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9520
Mailing Address - Country:US
Mailing Address - Phone:616-337-1541
Mailing Address - Fax:
Practice Address - Street 1:5082 BREEZEFIELD DR SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-9520
Practice Address - Country:US
Practice Address - Phone:616-337-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty