Provider Demographics
NPI:1619214475
Name:WYSSMANN PSYCHOLOGICAL & COUNSELING, LLC
Entity type:Organization
Organization Name:WYSSMANN PSYCHOLOGICAL & COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:WYSSMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-752-0677
Mailing Address - Street 1:1949 SUGARLAND DR
Mailing Address - Street 2:SUITE 218
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5755
Mailing Address - Country:US
Mailing Address - Phone:307-752-0677
Mailing Address - Fax:
Practice Address - Street 1:1949 SUGARLAND DR
Practice Address - Street 2:SUITE 218
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5755
Practice Address - Country:US
Practice Address - Phone:307-752-0677
Practice Address - Fax:307-674-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY881101YP2500X
WY403103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty