Provider Demographics
NPI:1912278219
Name:WAYNE HYATT COUNSELING, LLC
Entity Type:Organization
Organization Name:WAYNE HYATT COUNSELING, LLC
Other - Org Name:WHOLELIFE FAMILY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN, LMFT
Authorized Official - Phone:864-706-7932
Mailing Address - Street 1:306 SUNDANCE WAY
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-3725
Mailing Address - Country:US
Mailing Address - Phone:864-706-7932
Mailing Address - Fax:864-706-7932
Practice Address - Street 1:1090 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2247
Practice Address - Country:US
Practice Address - Phone:864-706-7932
Practice Address - Fax:864-706-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3377106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1211OtherLMFT
SC3377OtherLMFT