Provider Demographics
NPI:1225841646
Name:WYNNE, MELISSA AZENETH (LPC)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:AZENETH
Last Name:WYNNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19950 HUEBNER RD APT 809
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3296
Mailing Address - Country:US
Mailing Address - Phone:830-352-1201
Mailing Address - Fax:
Practice Address - Street 1:19950 HUEBNER RD APT 809
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3296
Practice Address - Country:US
Practice Address - Phone:830-352-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional