Provider Demographics
NPI:1578676615
Name:WYCOFF, NEIL G (LCPC)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:G
Last Name:WYCOFF
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 W JEFFERSON ST
Mailing Address - Street 2:STE 215
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5252
Mailing Address - Country:US
Mailing Address - Phone:815-773-0772
Mailing Address - Fax:815-773-0771
Practice Address - Street 1:3033 W JEFFERSON ST
Practice Address - Street 2:STE 215
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5252
Practice Address - Country:US
Practice Address - Phone:815-773-0772
Practice Address - Fax:815-773-0771
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional