Individual
DR. TIFFANY WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LPCC
Contact information
Practice address
2727 SAN PEDRO DR NE STE 110, ALBUQUERQUE, NM 87110-3373
(505) 670-7765
Mailing address
300 MENAUL BLVD NW # 2360, ALBUQUERQUE, NM 87107-1322
(505) 670-7765
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CCMH0203641
NM
101YP2500X
Professional Counselor
Primary
CCMH0203641
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32475764
—
NM
05
—
66738342
—
NM
Enumeration date
08/12/2015
Last updated
07/29/2024
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