1063829000 NPI number — MR. WILLIAM HUMBER WYSONG MA,LPC, EMDR II, TEP

Table of content: MR. WILLIAM HUMBER WYSONG MA,LPC, EMDR II, TEP (NPI 1063829000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063829000 NPI number — MR. WILLIAM HUMBER WYSONG MA,LPC, EMDR II, TEP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WYSONG
Provider First Name:
WILLIAM
Provider Middle Name:
HUMBER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA,LPC, EMDR II, TEP
Provider Gender Code:
M

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1063829000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
276 CRYSTAL PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANITOU SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80829-2841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-229-9120
Provider Business Mailing Address Fax Number:
719-685-2404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 N NEVADA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80903-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-632-0771
Provider Business Practice Location Address Fax Number:
719-685-2404
Provider Enumeration Date:
07/22/2014

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: 101YP2500X , with the licence number:  LPC 0000058 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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