Provider Demographics
NPI:1902139611
Name:WYNN, ALISON (LCSW)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:WYNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5126
Mailing Address - Country:US
Mailing Address - Phone:210-826-7325
Mailing Address - Fax:
Practice Address - Street 1:303 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5126
Practice Address - Country:US
Practice Address - Phone:210-826-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-13
Last Update Date:2009-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical