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General NPI Number Information
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NPI Number | 1053807313
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Entity Type | Individual
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Provider Name | JESSICA LAUREN WYNN LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 225 E CHEYENNE MOUNTAIN BLVD STE 220
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3700
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Country | US
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Telephone | 719-694-9739
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Fax |
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Provider Business Mailing Address
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Address Line | 5035 LANGDALE WAY
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-7673
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Country | US
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Telephone | 912-610-2107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LCM678
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MSMFT.0000005
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License Number State | CO
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