Individual
CALVIN WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7819 48TH AVE SE, LACEY, WA 98503-4609
(719) 209-1657
Mailing address
7819 48TH AVE SE, LACEY, WA 98503-4609
(719) 209-1657
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/06/2015
Last updated
01/06/2015
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