Provider Demographics
NPI:1013397595
Name:KYSER, WESLEY (LISW-S, LICDC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:KYSER
Suffix:
Gender:M
Credentials:LISW-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 SEQUOIA LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1730
Mailing Address - Country:US
Mailing Address - Phone:419-982-2400
Mailing Address - Fax:
Practice Address - Street 1:2 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-2855
Practice Address - Country:US
Practice Address - Phone:419-982-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161365101YA0400X
OHI.15000961041C0700X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional