Provider Demographics
NPI:1457833782
Name:WYATT PSYCHOLOGICAL SERVICES FOR SENIORS
Entity Type:Organization
Organization Name:WYATT PSYCHOLOGICAL SERVICES FOR SENIORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:614-214-5230
Mailing Address - Street 1:2435 PLEASANT COLONY DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9688
Mailing Address - Country:US
Mailing Address - Phone:614-214-5230
Mailing Address - Fax:740-879-3556
Practice Address - Street 1:2435 PLEASANT COLONY DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9688
Practice Address - Country:US
Practice Address - Phone:614-214-5230
Practice Address - Fax:740-879-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty