Teresa Lynne Wyatt, LCDC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

ILCDC 8755 Issued in TX

Practice address

4054 McKinney Ave Ste 102
Dallas, TX 75204-2050

Phone

(214) 520-6308

NPI assigned

Jun 26, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legacy Counseling Center Inc

  • Clinical Social Worker
  • Dallas, TX
  • NPI 1770510075
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912934217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4054 MCKINNEY AVE STE 102",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752042050",
            "telephone_number": "214-520-6308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4054 MCKINNEY AVE STE 102",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752042050",
            "telephone_number": "214-520-6308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "TERESA",
        "middle_name": "LYNNE",
        "credential": "LCDC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "ILCDC 8755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "8610BH",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Wurz, COTA
• Donald D Wurzburg, MD
• Andria Wyatt, BCBA, LBA
• David Erin Wyatt, MD
• J Robert Wyatt, MD
• Adam Thomas Wyble, PA-C
• Alexander Wyckoff, MD
• Myra Helen Wyckoff, MD
• Wycliff Pharmacy
• Stefani Ann Wylie, PT

• Addiction (Substance Use Disorder) Counselor in Dallas, TX
• Providers in Dallas, TX by specialty
• Addiction (Substance Use Disorder) Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.