Provider Demographics
NPI:1558814822
Name:WYCKOFF, KRISTI (LCSW, LSSW)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:WYCKOFF
Suffix:
Gender:F
Credentials:LCSW, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 COOPER LEDGE CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1471
Mailing Address - Country:US
Mailing Address - Phone:847-445-7968
Mailing Address - Fax:
Practice Address - Street 1:440 MCMURRAY DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5362
Practice Address - Country:US
Practice Address - Phone:615-333-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10212104100000X
TN6239901041S0200X
IL22923061041S0200X
TN74171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool