Provider Demographics
NPI:1598810137
Name:WILSON AND WYNN INTERVENTIONS, PLC
Entity Type:Organization
Organization Name:WILSON AND WYNN INTERVENTIONS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WYNN-STELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-647-3460
Mailing Address - Street 1:10843 CRAWFORD LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8771
Mailing Address - Country:US
Mailing Address - Phone:616-647-3460
Mailing Address - Fax:
Practice Address - Street 1:4519 CASCADE RD SE STE 6
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8319
Practice Address - Country:US
Practice Address - Phone:616-647-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008405101YM0800X, 103TM1800X
MI6301012332101YM0800X, 103TM1800X
MI68010830171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty