Provider Demographics
NPI:1760497184
Name:WYATT, VICKI HARRIS (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:HARRIS
Last Name:WYATT
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N WALKER AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1622
Mailing Address - Country:US
Mailing Address - Phone:405-232-1000
Mailing Address - Fax:405-232-4556
Practice Address - Street 1:501 N WALKER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1622
Practice Address - Country:US
Practice Address - Phone:405-232-1000
Practice Address - Fax:405-232-4556
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2916101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor