Provider Demographics
NPI:1063210011
Name:WYLIE, CORI H (LMSW)
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:H
Last Name:WYLIE
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72740-9672
Mailing Address - Country:US
Mailing Address - Phone:479-728-2878
Mailing Address - Fax:
Practice Address - Street 1:1104 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-9672
Practice Address - Country:US
Practice Address - Phone:479-728-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker