Provider Demographics
NPI:1811221757
Name:WYNNE, DEBORAH LYNNE (LPC, LCPAA, RPT-S)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNNE
Last Name:WYNNE
Suffix:
Gender:F
Credentials:LPC, LCPAA, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-4495
Mailing Address - Country:US
Mailing Address - Phone:469-877-4526
Mailing Address - Fax:214-660-1807
Practice Address - Street 1:5200 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-2006
Practice Address - Country:US
Practice Address - Phone:469-877-4526
Practice Address - Fax:214-660-1807
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional