Individual
TERESA LYNNE WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
4054 MCKINNEY AVE STE 102, DALLAS, TX 75204-2050
(214) 520-6308
Mailing address
4054 MCKINNEY AVE STE 102, DALLAS, TX 75204-2050
(214) 520-6308
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ILCDC 8755
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8610BH
BC/BS
—
Enumeration date
06/26/2006
Last updated
07/08/2007
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