Provider Demographics
NPI:1639788771
Name:WYNN, DAVID TYLER (LCMHC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TYLER
Last Name:WYNN
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 TUNNEL RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1919
Mailing Address - Country:US
Mailing Address - Phone:828-707-5751
Mailing Address - Fax:828-537-1551
Practice Address - Street 1:738 TUNNEL RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1919
Practice Address - Country:US
Practice Address - Phone:828-707-5751
Practice Address - Fax:828-537-1551
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional