Provider Demographics
NPI:1780885475
Name:STEWART-WYATT, LAURA JO (MA)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:JO
Last Name:STEWART-WYATT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 AZALEA CIR W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2764
Mailing Address - Country:US
Mailing Address - Phone:251-470-2550
Mailing Address - Fax:251-470-2541
Practice Address - Street 1:3103 AIRPORT BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3664
Practice Address - Country:US
Practice Address - Phone:251-470-2540
Practice Address - Fax:251-470-2541
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor