Individual
PORCHE WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LPC
Contact information
Practice address
318 N GAY ST STE 210, KNOXVILLE, TN 37917-7515
(865) 370-7705
Mailing address
318 N GAY ST STE 210, KNOXVILLE, TN 37917-7515
(865) 370-7705
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
4115
TN
101YP2500X
Professional Counselor
Primary
4115
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q032977
—
TN
Enumeration date
07/16/2009
Last updated
06/21/2024
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