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NPI Code Detail

MEDICARE: WYATT GROUP COUNSELING, PC

MEDICARE: WYATT GROUP COUNSELING, PC
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
1101Y00000XCounselor2916OK

General Provider Information

NPI Number : 1982054904
Entity Type Code : Organization
Provider Name (Legal Business Name) : WYATT GROUP COUNSELING, PC
Provider Business Mailing Address
First Line : PO BOX 1947
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73101-1947
Country : US
Telephone Number : 405-232-1000
Fax Number : 405-232-4556
Provider Business Practice Location Address
First Line : 501 N WALKER AVE
Second Line : SUITE 110
City : OKLAHOMA CITY
State : OK
Zip : 73102-1622
Country : US
Telephone Number : 405-232-1000
Fax Number : 405-232-4556
Authorized Official
Title or Position : OWNER/CHIEF THERAPIST
Name : DR. VICKI HARRIS WYATT
Credential : PH.D., LPC, LADC
Telephone Number : 405-232-1000
Provider Enumeration Date : 06/21/2016
Last Update Date : 06/21/2016

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