Provider Demographics
NPI:1720187867
Name:WYNIA, DEON J (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:DEON
Middle Name:J
Last Name:WYNIA
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CENTRAL AVE NW STE 300
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1332
Mailing Address - Country:US
Mailing Address - Phone:712-737-2635
Mailing Address - Fax:712-737-2344
Practice Address - Street 1:400 CENTRAL AVE NW STE 300
Practice Address - Street 2:SUITE 103
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1332
Practice Address - Country:US
Practice Address - Phone:712-737-2635
Practice Address - Fax:712-737-2344
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00291101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor