Individual
GAIL ELIZABETH WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
300 MEDICAL PLZ, LOS ANGELES, CA 90095-0001
(310) 825-9989
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY4395
CA
103TC0700X
Clinical Psychologist
Primary
PSY04395
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY043950
—
CA
Enumeration date
08/25/2006
Last updated
07/10/2013
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