Individual
DR. ELIZABETH BLAIR WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
8039 BROADMOOR RD, #15, MENTOR, OH 44060
(440) 269-1500
(440) 269-8545
Mailing address
8039 BROADMOOR RD, #15, MENTOR, OH 44060
(440) 269-1500
(440) 269-8545
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4508
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2065732
—
OH
Enumeration date
08/30/2006
Last updated
07/08/2007
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