Provider Demographics
NPI:1982167995
Name:WYATT, DREYTON (LPC)
Entity type:Individual
Prefix:
First Name:DREYTON
Middle Name:
Last Name:WYATT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8090 PRECINCT LINE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7677
Mailing Address - Country:US
Mailing Address - Phone:682-200-9541
Mailing Address - Fax:
Practice Address - Street 1:8090 PRECINCT LINE RD STE 103
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7677
Practice Address - Country:US
Practice Address - Phone:682-200-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional