Provider Information for 1851335368
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Prof. THOMAS W WYNNE LCSW
Sex: Male
NPI: 1851335368
Last Updated: 2010-10-20
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1851335368 | ||||||||
| Enumeration Date | 2006-06-15 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 50521 MIDLAND, TX 79710-0521 United States Phone: 432-599-1727 | Fax: | ||||||||
| Primary Practice Address | 6 DESTA DR SUITE 2640 MIDLAND, TX 79705-5520 United States Phone: 432-599-1727 | Fax: | ||||||||
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