Individual
MRS. KEITHA DONELLE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, C-SSWS, BHRS
Contact information
Practice address
4801 N CLASSEN BLVD, SUITE 233, OKLAHOMA CITY, OK 73118-4627
(405) 242-5031
Mailing address
1809 RASHEED RD, EDMOND, OK 73003-3809
(405) 340-6886
(405) 340-6886
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3971
OK
1041S0200X
School Social Worker
3971
OK
Other
Enumeration date
08/02/2010
Last updated
04/08/2011
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