Provider Demographics
NPI:1659026714
Name:PERTUSET, WYATT AUSTIN (CT)
Entity Type:Individual
Prefix:
First Name:WYATT
Middle Name:AUSTIN
Last Name:PERTUSET
Suffix:
Gender:M
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43344-1002
Mailing Address - Country:US
Mailing Address - Phone:740-341-6213
Mailing Address - Fax:
Practice Address - Street 1:1515 INDIANOLA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2118
Practice Address - Country:US
Practice Address - Phone:614-294-2661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health