Provider Demographics
NPI:1346863792
Name:WYNN, WILLIAM JOHN II
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:WYNN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20074
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89112-2074
Mailing Address - Country:US
Mailing Address - Phone:702-569-2250
Mailing Address - Fax:
Practice Address - Street 1:155 CADILLAC PL
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4355
Practice Address - Country:US
Practice Address - Phone:702-503-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor