Provider Demographics
NPI:1063533032
Name:WILEY, ROBERT ALLEN (MA, , LMHC, LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALLEN
Last Name:WILEY
Suffix:
Gender:M
Credentials:MA, , LMHC, LPC
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 585
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-0585
Mailing Address - Country:US
Mailing Address - Phone:989-859-7155
Mailing Address - Fax:
Practice Address - Street 1:16-179 MELEKAHIWA ST
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8026
Practice Address - Country:US
Practice Address - Phone:808-854-2837
Practice Address - Fax:808-969-3716
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006190101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor