Provider Demographics
NPI:1649694969
Name:WILEY, GINNY
Entity type:Individual
Prefix:
First Name:GINNY
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9646 MEADOWGLEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3722
Mailing Address - Country:US
Mailing Address - Phone:918-798-3214
Mailing Address - Fax:
Practice Address - Street 1:11999 KATY FWY
Practice Address - Street 2:SUITE 490
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1611
Practice Address - Country:US
Practice Address - Phone:713-365-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional