MEDICARE: WAYNE HYATT COUNSELING, LLC

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
1	106H00000X	Marriage & Family Therapist	3377	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1211	OTHER	NC	LMFT
2	3377	OTHER	SC	LMFT

General Provider Information

NPI Number	:	1912278219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE HYATT COUNSELING, LLC

Provider Business Mailing Address
First Line	:	306 SUNDANCE WAY
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29302-3725
Country	:	US
Telephone Number	:	864-706-7932
Fax Number	:	864-706-7932

Provider Business Practice Location Address
First Line	:	1090 BOILING SPRINGS RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29303-2247
Country	:	US
Telephone Number	:	864-706-7932
Fax Number	:	864-706-7932

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WAYNE F HYATT
Credential	:	D.MIN., LMFT
Telephone Number	:	864-706-7932

Provider Enumeration Date	:	01/18/2012
Last Update Date	:	01/18/2012

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