| Wyatt & Walker Llc | |
|
2637 Ridgewood Rd Ste 100 Jackson MS 39216-4922 | |
| (601) 981-8846 | |
| (601) 981-8873 |
| Full Name | Wyatt & Walker Llc |
|---|---|
| Speciality | Counselor |
| Location | 2637 Ridgewood Rd Ste 100, Jackson, Mississippi |
| Authorized Official Name and Position | Mollie L Wyatt (OWNER) |
| Authorized Official Contact | 6019818846 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wyatt & Walker Llc 2637 Ridgewood Rd Ste 100 Jackson MS 39216-4922 Ph: (601) 981-8846 | Wyatt & Walker Llc 2637 Ridgewood Rd Ste 100 Jackson MS 39216-4922 Ph: (601) 981-8846 |
| NPI Number | 1336815646 |
|---|---|
| Provider Enumeration Date | 08/17/2021 |
| Last Update Date | 08/17/2021 |
| Certification Date | 08/17/2021 |
| Medicare PECOS PAC ID | 6901260801 |
|---|---|
| Medicare Enrollment ID | O20230911003776 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336815646 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Mollie Wyatt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497968911 PECOS PAC ID: 7719341619 Enrollment ID: I20230911003808 |
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