Provider Demographics
NPI:1063488245
Name:BROMS, WYNNE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:WYNNE
Middle Name:E
Last Name:BROMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782 WARM SANDS CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-0910
Mailing Address - Country:US
Mailing Address - Phone:575-525-2425
Mailing Address - Fax:
Practice Address - Street 1:1615 S SOLANO DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5406
Practice Address - Country:US
Practice Address - Phone:575-525-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM529103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical