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General NPI Number Information
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NPI Number | 1982054904
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Entity Type | Organization
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Legal Business Name | WYATT GROUP COUNSELING, PC
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 501 N WALKER AVE SUITE 110
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City | OKLAHOMA CITY
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State | OK
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Zip | 73102-1622
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Country | US
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Telephone | 405-232-1000
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Fax | 405-232-4556
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Provider Business Mailing Address
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Address Line | PO BOX 1947
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City | OKLAHOMA CITY
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State | OK
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Zip | 73101-1947
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Country | US
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Telephone | 405-232-1000
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Fax | 405-232-4556
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Authorized Official
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Title or Position | OWNER/CHIEF THERAPIST
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Name | DR. VICKI HARRIS WYATT
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Credential | PH.D., LPC, LADC
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Telephone | 405-232-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2916
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License Number State | OK
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