Healthcare Provider Details

I. General information

NPI: 1417566852
Provider Name (Legal Business Name): MADISON WYANT LPC, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PENN AVE
BARTLESVILLE OK
74003-3847
US

IV. Provider business mailing address

700 S PENN AVE
BARTLESVILLE OK
74003-3847
US

V. Phone/Fax

Practice location:
  • Phone: 918-619-7343
  • Fax:
Mailing address:
  • Phone: 620-515-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5139
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10663
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: