Provider Demographics
NPI:1225452436
Name:WYANT, KATHY M (LPC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:M
Last Name:WYANT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 STEPHENS RD
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-1150
Mailing Address - Country:US
Mailing Address - Phone:864-723-3945
Mailing Address - Fax:
Practice Address - Street 1:515 CAMSON RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-1407
Practice Address - Country:US
Practice Address - Phone:864-716-2316
Practice Address - Fax:864-716-2321
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional