Provider Demographics
NPI:1386167369
Name:WILDEY, TONY TYE SR
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:TYE
Last Name:WILDEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 W RIVERVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1126
Mailing Address - Country:US
Mailing Address - Phone:775-741-1041
Mailing Address - Fax:
Practice Address - Street 1:210 MARSH AVE STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1698
Practice Address - Country:US
Practice Address - Phone:775-322-4003
Practice Address - Fax:775-322-4468
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0820106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist