Provider Demographics
NPI:1033879192
Name:WYSOSKI, ANNE CHRISTINE (MS, PCLC, LAC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:CHRISTINE
Last Name:WYSOSKI
Suffix:
Gender:F
Credentials:MS, PCLC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 SPRINGHILL LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-9321
Mailing Address - Country:US
Mailing Address - Phone:406-624-9131
Mailing Address - Fax:
Practice Address - Street 1:321 E MAIN ST STE 319
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4721
Practice Address - Country:US
Practice Address - Phone:406-624-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-43491101YM0800X
MTBBH-LAC-LIC-50451101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)