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NPI Code Detail

MEDICARE: DR. STEVEN CHARLES WYATT PH.D.

MEDICARE: DR. STEVEN CHARLES WYATT PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling PsychologistP2708TN
2103TC0700XClinical Psychologist2708TN

General Provider Information

NPI Number : 1134172562
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEVEN CHARLES WYATT PH.D.
Provider Business Mailing Address
First Line : 9041 EXECUTIVE PARK DR
Second Line : SUITE 210
City : KNOXVILLE
State : TN
Zip : 37923-4621
Country : US
Telephone Number : 865-603-2192
Fax Number : 865-381-0544
Provider Business Practice Location Address
First Line : 9041 EXECUTIVE PARK DR
Second Line : SUITE 210
City : KNOXVILLE
State : TN
Zip : 37923-4621
Country : US
Telephone Number : 865-603-2192
Fax Number : 865-381-0544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 05/30/2020

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