Provider Demographics
NPI:1689182495
Name:WYNFIELD, TED (MA, LPCC)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:
Last Name:WYNFIELD
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 OWL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2244
Mailing Address - Country:US
Mailing Address - Phone:720-933-3002
Mailing Address - Fax:
Practice Address - Street 1:2305 CANYON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5651
Practice Address - Country:US
Practice Address - Phone:970-528-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC-0016225101Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program