Provider Demographics
NPI:1245696129
Name:WYNN, JANICE ELAINE (MS)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:ELAINE
Last Name:WYNN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:WYNN
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:185 JUNIPER TRAIL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480
Mailing Address - Country:US
Mailing Address - Phone:352-857-9351
Mailing Address - Fax:
Practice Address - Street 1:185 JUNIPER TRAIL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34480
Practice Address - Country:US
Practice Address - Phone:352-857-9351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-08
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health