Healthcare Provider Details

I. General information

NPI: 1619214475
Provider Name (Legal Business Name): WYSSMANN PSYCHOLOGICAL & COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2013
Last Update Date: 01/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 SUGARLAND DR SUITE 218
SHERIDAN WY
82801-5755
US

IV. Provider business mailing address

1949 SUGARLAND DR SUITE 218
SHERIDAN WY
82801-5755
US

V. Phone/Fax

Practice location:
  • Phone: 307-752-0677
  • Fax: 307-674-1825
Mailing address:
  • Phone: 307-752-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number881
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number403
License Number StateWY

VIII. Authorized Official

Name: DR. JAMES W WYSSMANN
Title or Position: OWNER
Credential: PH.D.
Phone: 307-752-0677