Individual
CHRISTINA WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1014 MAIN ST, LEWISTON, ID 83501-1842
(208) 743-8101
Mailing address
1014 MAIN ST, LEWISTON, ID 83501-1842
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/08/2014
Last updated
03/31/2017
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