Provider Demographics
NPI:1942638010
Name:OKEEFE, WYATT (LMHC)
Entity Type:Individual
Prefix:
First Name:WYATT
Middle Name:
Last Name:OKEEFE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 1ST AVE N STE 2M PMB 1104
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8637
Mailing Address - Country:US
Mailing Address - Phone:352-677-2401
Mailing Address - Fax:
Practice Address - Street 1:3813 NW 32ND PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6161
Practice Address - Country:US
Practice Address - Phone:352-677-2401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLH11905101YP2500X
FLLH11305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional