Provider Demographics
NPI:1962020438
Name:WYLLYS, JONATHAN SCOTT (MA-LLPC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:WYLLYS
Suffix:
Gender:M
Credentials:MA-LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NORWAY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-1717
Mailing Address - Country:US
Mailing Address - Phone:989-348-7800
Mailing Address - Fax:989-348-5346
Practice Address - Street 1:501 NORWAY ST STE 1
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-1717
Practice Address - Country:US
Practice Address - Phone:989-348-7800
Practice Address - Fax:989-348-5346
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional