Provider Demographics
NPI:1184064644
Name:WYATT, ARON SR (LPC)
Entity type:Individual
Prefix:MR
First Name:ARON
Middle Name:
Last Name:WYATT
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7648 MINERAL CREST CIR N
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4779
Mailing Address - Country:US
Mailing Address - Phone:901-653-8933
Mailing Address - Fax:901-624-2513
Practice Address - Street 1:7648 MINERAL CREST CIR N
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4779
Practice Address - Country:US
Practice Address - Phone:901-653-8933
Practice Address - Fax:901-624-2513
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000002703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional