1215316062 NPI number — SKYE EILEEN WYRICK LCSW

Table of content: SKYE EILEEN WYRICK LCSW (NPI 1215316062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215316062 NPI number — SKYE EILEEN WYRICK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WYRICK
Provider First Name:
SKYE
Provider Middle Name:
EILEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALBERT
Provider Other First Name:
SKYE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215316062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROSBY
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58730-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-965-6521
Provider Business Mailing Address Fax Number:
701-965-6529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1044 S GRAPEVINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-9160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-295-6758
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  5041 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)