Provider Demographics
NPI:1528598687
Name:WYATT, TAMMY P (LPC)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:P
Last Name:WYATT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 PERIGON CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5072
Mailing Address - Country:US
Mailing Address - Phone:864-477-0638
Mailing Address - Fax:
Practice Address - Street 1:106 W GEORGIA RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2302
Practice Address - Country:US
Practice Address - Phone:864-477-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6359101YP2500X
SC6821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional