Provider Demographics
NPI:1689404691
Name:WILEY, MICAH (BA, MHP)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:BA, MHP
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:
Other - Last Name:HEDDINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MHP
Mailing Address - Street 1:12 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951-1907
Mailing Address - Country:US
Mailing Address - Phone:217-728-4358
Mailing Address - Fax:217-728-2270
Practice Address - Street 1:12 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-1907
Practice Address - Country:US
Practice Address - Phone:217-728-4358
Practice Address - Fax:217-728-2270
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health