Provider Demographics
NPI:1598889446
Name:WYCKOFF, ROXANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:WYCKOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SOUTHWICK
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:TX
Mailing Address - Zip Code:75152-9587
Mailing Address - Country:US
Mailing Address - Phone:972-845-2535
Mailing Address - Fax:972-845-2467
Practice Address - Street 1:203 S COLLEGE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3731
Practice Address - Country:US
Practice Address - Phone:972-845-2535
Practice Address - Fax:972-845-2467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical