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NPI Code Detail

MEDICARE: DEMETRIC U WYATT LCSW

MEDICARE: DEMETRIC U WYATT LCSW
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
11041C0700XClinical Social Worker6294-CAR

General Provider Information

NPI Number : 1740206531
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEMETRIC U WYATT LCSW
Provider Business Mailing Address
First Line : 4253 N CROSSOVER RD
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-4593
Country : US
Telephone Number : 479-521-5731
Fax Number : 479-521-6520
Provider Business Practice Location Address
First Line : 5700 PHOENIX PL
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-5782
Country : US
Telephone Number : 479-441-2600
Fax Number : 479-441-2693
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 04/16/2025

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Directions to “ DEMETRIC U WYATT LCSW” Practice Location

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