Healthcare Provider Details

I. General information

NPI: 1760726756
Provider Name (Legal Business Name): DEBRA ANN WYSOSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA ANN MARTIN

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 STADIUM DR SUITE 101
ARLINGTON TX
76011-6246
US

IV. Provider business mailing address

2100 EMERALD LAKE DR
ARLINGTON TX
76013-5216
US

V. Phone/Fax

Practice location:
  • Phone: 817-501-4925
  • Fax:
Mailing address:
  • Phone: 817-457-2359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number59943
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: