Provider Demographics
NPI:1053415323
Name:WYSOCK, M ROXANNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:M
Middle Name:ROXANNE
Last Name:WYSOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE HOSPITAL DR
Mailing Address - Street 2:BEHAVIORAL HEALTH-CRESTWOOD MEDICAL CENTER
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-880-4261
Mailing Address - Fax:256-880-4248
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:BEHAVIORAL HEALTH-CRESTWOOD MEDICAL CENTER
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-880-4261
Practice Address - Fax:256-880-4248
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional