Provider Demographics
NPI:1770279309
Name:WILEY, EDNA BERNICE (MFT-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:BERNICE
Last Name:WILEY
Suffix:
Gender:F
Credentials:MFT-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-4452
Mailing Address - Country:US
Mailing Address - Phone:817-966-7384
Mailing Address - Fax:
Practice Address - Street 1:2770 MAIN ST STE 142
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4360
Practice Address - Country:US
Practice Address - Phone:214-606-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health