MEDICARE: MRS. DEBORAH LYNNE WYNNE LPC, LCPAA, RPT-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	13594	TX

General Provider Information

NPI Number	:	1811221757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH LYNNE WYNNE LPC, LCPAA, RPT-S

Provider Business Mailing Address
First Line	:	1452 WATERSIDE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-4495
Country	:	US
Telephone Number	:	469-877-4526
Fax Number	:	214-660-1807

Provider Business Practice Location Address
First Line	:	5200 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-2006
Country	:	US
Telephone Number	:	469-877-4526
Fax Number	:	214-660-1807

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/24/2009

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