Provider Demographics
NPI:1063579613
Name:WYNN, VERONICA MARIE (MFT)
Entity type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:MARIE
Last Name:WYNN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 CONNORS CT STE G
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1178
Mailing Address - Country:US
Mailing Address - Phone:530-327-8084
Mailing Address - Fax:530-809-4440
Practice Address - Street 1:383 CONNORS CT STE G
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1178
Practice Address - Country:US
Practice Address - Phone:530-327-8084
Practice Address - Fax:530-809-4440
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44020106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist