Provider Demographics
NPI:1407362874
Name:WYKES, THOMAS JR (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:WYKES
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 CENTRAL AVE
Mailing Address - Street 2:STE F
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3754
Mailing Address - Country:US
Mailing Address - Phone:480-332-7146
Mailing Address - Fax:
Practice Address - Street 1:526 REGENCY DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5106
Practice Address - Country:US
Practice Address - Phone:307-222-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY643103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist