Tiffany Wynn, PHD, LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CCMH0203641 Issued in NM

Practice address

2727 San Pedro Dr NE Ste 110
Albuquerque, NM 87110-3373

Phone

(505) 670-7765

NPI assigned

Aug 12, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New Experiences Counseling and Consultation, LLC

  • Professional Counselor
  • Albuquerque, NM
  • NPI 1679330138
  Medicare reassignment NPD Authorized official
• Choice Recovery Path LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Albuquerque, NM
  • NPI 1346981651

  Multi-Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722211200000",
    "number": "1225404437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MENAUL BLVD NW # 2360",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871071322",
            "telephone_number": "505-670-7765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 SAN PEDRO DR NE STE 110",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871103373",
            "telephone_number": "505-670-7765"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1524 bishops lodge rd",
            "address_2": "#B",
            "address_purpose": "LOCATION",
            "city": "tesuque",
            "state": "NM",
            "postal_code": "87506",
            "country_code": "US",
            "telephone_number": "505-490-3547",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYNN",
        "first_name": "TIFFANY",
        "name_prefix": "Dr.",
        "credential": "PHD, LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-12",
        "last_updated": "2024-07-29",
        "certification_date": "2024-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NM",
            "license": "CCMH0203641",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NM",
            "license": "CCMH0203641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32475764",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "66738342",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Henry Wylie, MD
• Danielle Liegh Wyne, LMHC
• Maia A Wynn, MOTR-L
• Mary Wynn
• Russell Reese Wynn, LISW
• Bruna Brum Wynne, APRN-CNP
• Egan Wynne
• Louis Wynne, PH.D.
• Sarah Michelle Wynne, MA, LPCC, RPT, NCC
• X-Ray Associates of New Mexico PC

• Professional Counselor in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Professional Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.