Provider Demographics
NPI:1881287464
Name:MARY ANN WYATT LPC LLC
Entity type:Organization
Organization Name:MARY ANN WYATT LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:816-425-2833
Mailing Address - Street 1:PO BOX 4374
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-4374
Mailing Address - Country:US
Mailing Address - Phone:816-425-2833
Mailing Address - Fax:816-425-2098
Practice Address - Street 1:1030 KINGSHIGHWAY ST STE A
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2930
Practice Address - Country:US
Practice Address - Phone:816-425-2833
Practice Address - Fax:816-425-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty