Provider Demographics
NPI:1386166478
Name:WYNTER, MALIK ANTHONY (MSW, CSW-I)
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:ANTHONY
Last Name:WYNTER
Suffix:
Gender:M
Credentials:MSW, CSW-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8449 INDIGO SKY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129
Mailing Address - Country:US
Mailing Address - Phone:315-406-8563
Mailing Address - Fax:
Practice Address - Street 1:7373 PEAK DR STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9004
Practice Address - Country:US
Practice Address - Phone:702-471-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9887-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker