Active NPI
Therese K Wyatt, LAPC
- Mental Health Counselor
- Marietta, GA
National Provider Identifier
1134539299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- APC004095
- Practice address
- 2993 Sandy Plains Rd
Suite 115
Marietta, GA 30066-4695 - Phone
- (770) 910-2753
- NPI assigned
- Apr 29, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | APC004095 | GA | Primary |
Addresses
Primary practice location
2993 Sandy Plains Rd
Suite 115
Marietta, GA 30066-4695
Mailing address
1105 Wiley Bridge Rd
Woodstock, GA 30188-4628
Phone (678) 898-2335
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APC004095 | GA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398729600000",
"number": "1134539299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 WILEY BRIDGE RD",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301884628",
"telephone_number": "678-898-2335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2993 SANDY PLAINS RD",
"address_2": "SUITE 115",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300664695",
"telephone_number": "770-910-2753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "THERESE",
"middle_name": "K",
"name_prefix": "Mrs.",
"credential": "LAPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-04-29",
"last_updated": "2014-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "APC004095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.