Provider Demographics
NPI:1386743003
Name:STEVEN C. WYATT, PH.D., INC
Entity type:Organization
Organization Name:STEVEN C. WYATT, PH.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-603-2192
Mailing Address - Street 1:9041 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-603-2192
Mailing Address - Fax:865-381-0544
Practice Address - Street 1:9041 EXECUTIVE PARK DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-603-2192
Practice Address - Fax:865-381-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2708103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty