Provider Demographics
NPI:1194368282
Name:WYNN THERAPEUTIC COUNSELING
Entity Type:Organization
Organization Name:WYNN THERAPEUTIC COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-327-8084
Mailing Address - Street 1:383 CONNORS CT STE G
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1178
Mailing Address - Country:US
Mailing Address - Phone:530-327-8084
Mailing Address - Fax:530-809-4440
Practice Address - Street 1:1074 EAST AVE STE A1
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1000
Practice Address - Country:US
Practice Address - Phone:530-327-8084
Practice Address - Fax:530-809-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health