Provider Demographics
NPI:1215166087
Name:HARWELL, WILEY DUANE (DMIN, LPC)
Entity type:Individual
Prefix:DR
First Name:WILEY
Middle Name:DUANE
Last Name:HARWELL
Suffix:
Gender:M
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W GRAY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-7103
Mailing Address - Country:US
Mailing Address - Phone:405-329-8821
Mailing Address - Fax:405-801-3330
Practice Address - Street 1:300 W GRAY ST STE 102
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7103
Practice Address - Country:US
Practice Address - Phone:405-329-8821
Practice Address - Fax:405-801-3330
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional