Provider Demographics
NPI:1477334068
Name:WIATT, CALLI MARIE (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:CALLI
Middle Name:MARIE
Last Name:WIATT
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:CALLI
Other - Middle Name:MARIE
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PLPC, NCC
Mailing Address - Street 1:1691 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-1039
Mailing Address - Country:US
Mailing Address - Phone:417-848-3422
Mailing Address - Fax:
Practice Address - Street 1:7602 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2106
Practice Address - Country:US
Practice Address - Phone:417-848-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020005186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health