Provider Demographics
NPI:1215142633
Name:WYNDER, RYAN CURTIS (MS, MFT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:CURTIS
Last Name:WYNDER
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:CURTIS
Other - Last Name:WYNDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:10143 DEEP GLEN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-6501
Mailing Address - Country:US
Mailing Address - Phone:702-247-1352
Mailing Address - Fax:
Practice Address - Street 1:9402 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8312
Practice Address - Country:US
Practice Address - Phone:702-743-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist