Healthcare Provider Details

I. General information

NPI: 1710252333
Provider Name (Legal Business Name): MARY ANN WYATT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 SAINT ROBERT BLVD STE 3-504
SAINT ROBERT MO
65584-3323
US

IV. Provider business mailing address

213 SAINT ROBERT BLVD STE 3-504
SAINT ROBERT MO
65584-3323
US

V. Phone/Fax

Practice location:
  • Phone: 816-425-2833
  • Fax: 816-425-2098
Mailing address:
  • Phone: 816-425-2833
  • Fax: 816-425-2098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2012036248
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: