Wyatt, Jennifer Rene

Wyatt, Jennifer Rene is an individual health care provider with primary practice located at 321 W Walnut St , Johnson City TN 37604-6774. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavioral Analyst, which is considered as her primary health care specialty. Wyatt, Jennifer Rene can be contacted via phone (423) 202-3622.

Contact Information

Primary practice address
321 W Walnut St Johnson City TN 37604-6774
Phone: (423) 202-3622
Fax: (423) 631-0019
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X 1-20-42266 Colorado

Profile Details

NPI number 1720697642
LBN Legal business name Wyatt, Jennifer Rene
Credentials M.S., BCBA, LBA
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2020
Last updated Sep 2nd, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720697642 NPPES
Tennessee Other LBA0000000647 LICENSED BEHAVIOR ANALYST
Tennessee Other 0133001934 LICENSED BEHAVIOR ANALYST
Tennessee MEDICAID Q060405 LICENSED BEHAVIOR ANALYST

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