Individual
JENNIFER RENE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., BCBA, LBA
Contact information
Practice address
321 W WALNUT ST, JOHNSON CITY, TN 37604-6774
(423) 202-3622
(423) 631-0019
Mailing address
321 W WALNUT ST, BOX 2, JOHNSON CITY, TN 37604-6774
(423) 202-3622
(423) 631-0019
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-42266
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0133001934
LICENSED BEHAVIOR ANALYST
VA
01
—
LBA0000000647
LICENSED BEHAVIOR ANALYST
TN
05
—
Q060405
—
TN
Enumeration date
07/27/2020
Last updated
09/02/2025
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