Provider Demographics
NPI:1710215033
Name:WYATT, COLE HAMILTON
Entity Type:Individual
Prefix:MR
First Name:COLE
Middle Name:HAMILTON
Last Name:WYATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 WALNUT ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4938
Mailing Address - Country:US
Mailing Address - Phone:916-333-9040
Mailing Address - Fax:
Practice Address - Street 1:592 RIO LINDO AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1817
Practice Address - Country:US
Practice Address - Phone:530-891-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor