Provider Demographics
NPI:1255897369
Name:WESLEY, KIARA CHANEL CARYL (PHD)
Entity type:Individual
Prefix:DR
First Name:KIARA
Middle Name:CHANEL CARYL
Last Name:WESLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751831
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89136-1831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 OCEANGATE, SUITE 700
Practice Address - Street 2:VISN 22 DESERT PACIFIC HEALTHCARE SYSTEM
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4391
Practice Address - Country:US
Practice Address - Phone:562-829-5963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30625103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist