Provider Demographics
NPI:1689083883
Name:WINN, GERALD WAYNE (MS, LCDC, ADC, SAP)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:WAYNE
Last Name:WINN
Suffix:
Gender:M
Credentials:MS, LCDC, ADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7166 MESCO DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-6905
Mailing Address - Country:US
Mailing Address - Phone:979-703-8292
Mailing Address - Fax:979-703-8294
Practice Address - Street 1:7166 MESCO DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77808-6905
Practice Address - Country:US
Practice Address - Phone:979-703-8292
Practice Address - Fax:979-703-8294
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12385101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)