Provider Demographics
NPI:1073651790
Name:LANCASTER-BROWN, WYNN (MS)
Entity Type:Individual
Prefix:
First Name:WYNN
Middle Name:
Last Name:LANCASTER-BROWN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3242
Mailing Address - Country:US
Mailing Address - Phone:270-442-8785
Mailing Address - Fax:270-443-1784
Practice Address - Street 1:2204 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3242
Practice Address - Country:US
Practice Address - Phone:270-442-8785
Practice Address - Fax:270-443-1784
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical