Provider Demographics
NPI:1982054904
Name:WYATT GROUP COUNSELING, PC
Entity Type:Organization
Organization Name:WYATT GROUP COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LADC
Authorized Official - Phone:405-232-1000
Mailing Address - Street 1:PO BOX 1947
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73101-1947
Mailing Address - Country:US
Mailing Address - Phone:405-232-1000
Mailing Address - Fax:405-232-4556
Practice Address - Street 1:501 N WALKER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1622
Practice Address - Country:US
Practice Address - Phone:405-232-1000
Practice Address - Fax:405-232-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2916101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty