Healthcare Provider Details

I. General information

NPI: 1699668863
Provider Name (Legal Business Name): THREE TWELVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5057 CARILLON LN
WINDERMERE FL
34786-3117
US

IV. Provider business mailing address

5057 CARILLON LN
WINDERMERE FL
34786-3117
US

V. Phone/Fax

Practice location:
  • Phone: 515-509-5670
  • Fax:
Mailing address:
  • Phone: 515-509-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTIAN LANCE WIMMER
Title or Position: OWNER
Credential: PHD
Phone: 515-509-5670