Provider Demographics
NPI:1871681452
Name:WYATT, WILLAIM JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLAIM
Middle Name:JOSEPH
Last Name:WYATT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-0844
Mailing Address - Country:US
Mailing Address - Phone:304-696-2778
Mailing Address - Fax:304-696-2784
Practice Address - Street 1:DEPARTMENT OF PSYCHOLOGY
Practice Address - Street 2:1 JOHN MARSHALL DR.
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25526-2672
Practice Address - Country:US
Practice Address - Phone:304-696-2778
Practice Address - Fax:304-696-2784
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV196103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist