Individual
EARNEST JEROME WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
238 STUBBS VINSON ROAD, MONROE, LA 71203-5869
(318) 503-6902
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
5202
LA
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
10/05/2015
Last updated
10/30/2024
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