Provider Demographics
NPI:1003529868
Name:WYCHE, KATRINA JEAN (EDD, OCPC, CDCA)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:JEAN
Last Name:WYCHE
Suffix:
Gender:F
Credentials:EDD, OCPC, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VALE AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2160
Mailing Address - Country:US
Mailing Address - Phone:513-580-3200
Mailing Address - Fax:
Practice Address - Street 1:203 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45216-1353
Practice Address - Country:US
Practice Address - Phone:513-948-0023
Practice Address - Fax:513-948-0087
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
OHCDCA.181204101YA0400X
OHOCPC.161325405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health
No405300000XOther Service ProvidersPrevention Professional