Provider Demographics
NPI:1215596176
Name:WYCKHUYS, KRISTOPHER KOLE
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:KOLE
Last Name:WYCKHUYS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-1579 KUHIO HWY
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1835
Mailing Address - Country:US
Mailing Address - Phone:808-821-0574
Mailing Address - Fax:
Practice Address - Street 1:4-1579 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1835
Practice Address - Country:US
Practice Address - Phone:808-821-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor