Provider Demographics
NPI:1346671682
Name:T. WYATT LLC
Entity Type:Organization
Organization Name:T. WYATT LLC
Other - Org Name:TRACEY K. WYATT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:800-340-8020
Mailing Address - Street 1:834 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2724
Mailing Address - Country:US
Mailing Address - Phone:800-340-8020
Mailing Address - Fax:
Practice Address - Street 1:834 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2724
Practice Address - Country:US
Practice Address - Phone:800-340-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006178251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health