Provider Demographics
NPI:1518018829
Name:WYATT, WENDYANN RUTH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:WENDYANN
Middle Name:RUTH
Last Name:WYATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 PINE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5516
Mailing Address - Country:US
Mailing Address - Phone:228-872-3455
Mailing Address - Fax:
Practice Address - Street 1:888 PINE HILLS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5516
Practice Address - Country:US
Practice Address - Phone:228-872-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW77731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical