Provider Demographics
NPI:1730354473
Name:DENISE DAWN WYCHE
Entity type:Organization
Organization Name:DENISE DAWN WYCHE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:WYCHE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:832-213-6805
Mailing Address - Street 1:PO BOX 1637
Mailing Address - Street 2:3306 5TH STREET SUITE 3
Mailing Address - City:BROOKSHIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77423-1637
Mailing Address - Country:US
Mailing Address - Phone:832-213-6805
Mailing Address - Fax:
Practice Address - Street 1:3306 5TH ST # 2
Practice Address - Street 2:
Practice Address - City:BROOKSHIRE
Practice Address - State:TX
Practice Address - Zip Code:77423-8793
Practice Address - Country:US
Practice Address - Phone:832-213-6805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty