Provider Demographics
NPI:1588475768
Name:WYNN, JASMINE ZAIRE (MSW)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:ZAIRE
Last Name:WYNN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JASMINE
Other - Middle Name:ZAIRE
Other - Last Name:WYNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:37164 S HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7214
Mailing Address - Country:US
Mailing Address - Phone:313-689-3988
Mailing Address - Fax:
Practice Address - Street 1:37164 S HEATHER CT
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7214
Practice Address - Country:US
Practice Address - Phone:313-689-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851117543101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor