Individual
JERRY WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MBS
Contact information
Practice address
1925 W ELM ST, DURANT, OK 74701-3429
(580) 924-6363
(580) 924-0379
Mailing address
1925 W ELM ST, DURANT, OK 74701-3429
(580) 924-6363
(580) 924-0379
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3456
OK
Other
Enumeration date
03/13/2007
Last updated
08/21/2008
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