Provider Demographics
NPI:1962186163
Name:KEUTER, WYATT (MS)
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:
Last Name:KEUTER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E 11TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3746
Mailing Address - Country:US
Mailing Address - Phone:458-205-6403
Mailing Address - Fax:
Practice Address - Street 1:770 E 11TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3746
Practice Address - Country:US
Practice Address - Phone:458-205-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor