Healthcare Provider Details

I. General information

NPI: 1699648204
Provider Name (Legal Business Name): WYNNE WHITLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 21ST AVE S STE C400
NASHVILLE TN
37212-4350
US

IV. Provider business mailing address

1817 CEDAR LN
NASHVILLE TN
37212-5813
US

V. Phone/Fax

Practice location:
  • Phone: 615-492-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7401
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: