Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2014012320 | MO |
NPI | 1003279555 |
---|---|
Provider Name | Darla Wyatt |
First Address | Joplin, MO 64804 |
Second Address | Joplin, MO 64804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2016 |
Last Update Date | 01/04/2016 |