Doctor Name: | MR. KEVIN WYSE |
NPI Number: | 1023280864 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.ED., LCPC |
License Number: | 628 |
Business Practice Address: | 45 Medical Park Dr Helena, MT - 596014949 |
Business Phone Number: | 4062664903 |
Business Fax Number: | 4062664904 |
Mailing Address: | Po Box 127, TOWNSEND |
State: | MT |
Postal Code: | 596440127 |
Phone Number: | 4062664903 |
Fax Number: | 4062664904 |
NPI Enumeration Date: | 04/01/2008 |
NPI Last Update Date: | 04/01/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 628 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |