Provider Demographics
NPI:1144285198
Name:WYMA, JOHN G (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:WYMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8531 SILVER SHORES DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-2151
Mailing Address - Country:US
Mailing Address - Phone:928-308-2372
Mailing Address - Fax:
Practice Address - Street 1:975 KIRMAN AVE
Practice Address - Street 2:VA SIERRA NEVADA HEALTH CARE SYSTEM
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-326-2920
Practice Address - Fax:775-337-2223
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1452103TC0700X
AR14-11P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZPHD1452Medicare PIN
AZ860756002OtherCHAMPUS
AZAZ0606890OtherBLUE CROSS/ BLUE SHIELD