Provider Demographics
NPI:1124192463
Name:HYATT, WAYNE C (LPC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:C
Last Name:HYATT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 HUNTERS MILL TRL
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2394
Mailing Address - Country:US
Mailing Address - Phone:901-854-9454
Mailing Address - Fax:901-684-1277
Practice Address - Street 1:5350 POPLAR AVE STE 730
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3697
Practice Address - Country:US
Practice Address - Phone:901-683-5683
Practice Address - Fax:901-684-1277
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health