Provider Demographics
NPI:1174180939
Name:WYNN, KARAH (MSW, LCSW, PMH-C)
Entity Type:Individual
Prefix:
First Name:KARAH
Middle Name:
Last Name:WYNN
Suffix:
Gender:F
Credentials:MSW, LCSW, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 ENGLE RD STE 304
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2227
Mailing Address - Country:US
Mailing Address - Phone:260-483-2400
Mailing Address - Fax:
Practice Address - Street 1:7230 ENGLE RD STE 304
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2227
Practice Address - Country:US
Practice Address - Phone:260-483-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33008369A1041C0700X
IN34008691A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical