Healthcare Provider Details

I. General information

NPI: 1124192463
Provider Name (Legal Business Name): WAYNE C HYATT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 POPLAR AVE STE 730
MEMPHIS TN
38119-3697
US

IV. Provider business mailing address

1419 HUNTERS MILL TRL
COLLIERVILLE TN
38017-2394
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-5683
  • Fax: 901-684-1277
Mailing address:
  • Phone: 901-854-9454
  • Fax: 901-684-1277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0000000752
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: