Provider Demographics
NPI:1003450545
Name:WYCUFF, ADRIANNA P
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:P
Last Name:WYCUFF
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SANBORN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1769
Mailing Address - Country:US
Mailing Address - Phone:231-580-8482
Mailing Address - Fax:888-509-1505
Practice Address - Street 1:110 SANBORN AVE STE B
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1769
Practice Address - Country:US
Practice Address - Phone:231-580-8482
Practice Address - Fax:888-509-1505
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X
MI6401224801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health