Healthcare Provider Details

I. General information

NPI: 1922962570
Provider Name (Legal Business Name): LINDSAY WYATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 E BASELINE RD STE 106
GILBERT AZ
85234-2739
US

IV. Provider business mailing address

4641 S CONCORDE LN
MESA AZ
85212-9418
US

V. Phone/Fax

Practice location:
  • Phone: 602-341-3453
  • Fax:
Mailing address:
  • Phone: 812-786-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: