Provider Demographics
NPI:1962759613
Name:WILEY, MELICA SHAUNTE (MS)
Entity type:Individual
Prefix:MS
First Name:MELICA
Middle Name:SHAUNTE
Last Name:WILEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 ROCK CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-6272
Mailing Address - Country:US
Mailing Address - Phone:913-683-4757
Mailing Address - Fax:
Practice Address - Street 1:611 ROCK CREEK DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6272
Practice Address - Country:US
Practice Address - Phone:913-683-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist