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NPI Code Detail

MEDICARE: MS. LISA A WYATT M.S.

MEDICARE: MS. LISA A WYATT M.S.
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1457417644
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA A WYATT M.S.
Provider Business Mailing Address
First Line : 3795 E SHIELDS AVE
Second Line :
City : FRESNO
State : CA
Zip : 93726-7029
Country : US
Telephone Number : 559-229-3561
Fax Number :
Provider Business Practice Location Address
First Line : 3795 E SHIELDS AVE
Second Line :
City : FRESNO
State : CA
Zip : 93726-7029
Country : US
Telephone Number : 559-229-3561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 03/15/2011

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