Individual
AMANDA M WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, ATR-BC, LMHC
Contact information
Practice address
601 WALL ST, VALPARAISO, IN 46383-2512
(219) 531-3500
Mailing address
601 WALL ST, VALPARAISO, IN 46383-2512
(219) 531-3500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001619A
IN
101YP2500X
Professional Counselor
180-005554
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-139
ART THERAPY BD. CERT.
—
01
—
180-005554
LCPC
IL
01
—
39001619A
LMHC
IN
Enumeration date
10/31/2005
Last updated
06/01/2010
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