Provider Demographics
NPI:1427305119
Name:MELLAND, WYNNE ELAINE (LPC)
Entity type:Individual
Prefix:MRS
First Name:WYNNE
Middle Name:ELAINE
Last Name:MELLAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19743 ENCINO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2328
Mailing Address - Country:US
Mailing Address - Phone:210-862-1787
Mailing Address - Fax:
Practice Address - Street 1:19743 ENCINO WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2328
Practice Address - Country:US
Practice Address - Phone:210-862-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4816101Y00000X
TX63343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional