Provider Demographics
NPI:1801998760
Name:WYLIE, TERI ANN (MA LP)
Entity type:Individual
Prefix:MRS
First Name:TERI
Middle Name:ANN
Last Name:WYLIE
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:900 LONG LAKE RD
Mailing Address - Street 2:SUITE 320 ARDEN WOODS PSYCHOLOGICAL SERVICES
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6428
Mailing Address - Country:US
Mailing Address - Phone:651-482-9361
Mailing Address - Fax:651-482-9888
Practice Address - Street 1:900 LONG LAKE RD
Practice Address - Street 2:SUITE 320 ARDEN WOODS PSYCHOLOGICAL SERVICES
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6428
Practice Address - Country:US
Practice Address - Phone:651-482-9361
Practice Address - Fax:651-482-9888
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNLP 3760103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical