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General NPI Number Information
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NPI Number | 1104273887
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Entity Type | Individual
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Provider Name | JUDITH WYMER
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Gender | Female
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 02/19/2020
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Provider Practice Location Address
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Address Line | 117 W MAIN ST STE 205
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City | LANCASTER
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State | OH
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Zip | 43130-3799
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Country | US
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Telephone | 407-422-9350
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Fax |
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Provider Business Mailing Address
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Address Line | 117 W MAIN ST STE 205
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City | LANCASTER
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State | OH
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Zip | 43130-3799
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Country | US
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Telephone | 407-422-9350
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.0900579
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License Number State | OH
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