Provider Demographics
NPI:1275972523
Name:WYSE, CHRISTINA R (BCBA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:R
Last Name:WYSE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:WELDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:9929 E 126TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-9404
Mailing Address - Country:US
Mailing Address - Phone:317-436-8961
Mailing Address - Fax:317-991-1593
Practice Address - Street 1:30380 COUNTRY ROAD 6
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-9514
Practice Address - Country:US
Practice Address - Phone:574-343-2001
Practice Address - Fax:317-991-1593
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-12613103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst