Provider Demographics
NPI:1346638376
Name:WIRT, YVETTE (PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:WIRT
Suffix:
Gender:F
Credentials:PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5539 SOUNDSIDE DR UNIT L
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563
Mailing Address - Country:US
Mailing Address - Phone:850-376-2129
Mailing Address - Fax:
Practice Address - Street 1:5539 SOUNDSIDE DR APT L
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9528
Practice Address - Country:US
Practice Address - Phone:850-376-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor