Provider Demographics
NPI:1215316062
Name:WYRICK, SKYE EILEEN (LCSW)
Entity type:Individual
Prefix:
First Name:SKYE
Middle Name:EILEEN
Last Name:WYRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SKYE
Other - Middle Name:
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 HAYFIELD LOOP TRL
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-9171
Mailing Address - Country:US
Mailing Address - Phone:720-296-6758
Mailing Address - Fax:
Practice Address - Street 1:222 E MAIN ST UNIT 1E
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-9230
Practice Address - Country:US
Practice Address - Phone:720-295-6758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5041104100000X
CO099283971041C0700X
MT705231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker