Provider Demographics
NPI:1538435151
Name:WYLIE, FRANKLIN D (LICDC-CS, ICCS)
Entity type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:D
Last Name:WYLIE
Suffix:
Gender:M
Credentials:LICDC-CS, ICCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 FOLSOM DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1111
Mailing Address - Country:US
Mailing Address - Phone:859-630-2045
Mailing Address - Fax:
Practice Address - Street 1:219 FOLSOM DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1111
Practice Address - Country:US
Practice Address - Phone:859-630-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.081254101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0179331Medicaid