Provider Demographics
NPI:1992278055
Name:WYATT, NATALIE MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:WYATT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 FOOTHILL BLVD APT 5B
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-3029
Mailing Address - Country:US
Mailing Address - Phone:909-239-6858
Mailing Address - Fax:
Practice Address - Street 1:680 LANGSDORF DR STE 219
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3702
Practice Address - Country:US
Practice Address - Phone:714-578-0990
Practice Address - Fax:714-449-9252
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health