Provider Demographics
NPI:1144207721
Name:WYATT, CYNTHIA ANN MILLER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ANN MILLER
Last Name:WYATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7206 FLOWERING ALMOND DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-5499
Mailing Address - Country:US
Mailing Address - Phone:940-337-1550
Mailing Address - Fax:
Practice Address - Street 1:100 W ENT AVE
Practice Address - Street 2:BUILDING 725
Practice Address - City:PETERSON SPACE FORCE BASE
Practice Address - State:CO
Practice Address - Zip Code:80916
Practice Address - Country:US
Practice Address - Phone:719-556-8943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9892261041C0700X
LA84411041C0700X
TX418741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical