Provider Demographics
NPI:1740069897
Name:DAY, WYATT TAYLOR (LCSW)
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:TAYLOR
Last Name:DAY
Suffix:
Gender:X
Credentials:LCSW
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:TAYLOR
Other - Last Name:PAGE-RUSSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40162
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87196-0162
Mailing Address - Country:US
Mailing Address - Phone:505-730-5463
Mailing Address - Fax:
Practice Address - Street 1:820 JOHN ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4235
Practice Address - Country:US
Practice Address - Phone:505-730-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical