Individual provider Active NPI

Heather Anne Wynn, LMHC

  • Mental Health Counselor
  • Bonita Springs, FL
National Provider Identifier
1669612917
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH10531 Issued in FL
Practice address
9220 Bonita Beach Rd SE Ste 200
Bonita Springs, FL 34135-4231
Phone
(239) 537-2236
Fax
(239) 677-3025
NPI assigned
Feb 26, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Mental Health Counselor 101YM0800X MH10531 FL Primary

Addresses

Primary practice location

9220 Bonita Beach Rd SE Ste 200
Bonita Springs, FL 34135-4231

Mailing address

9220 Bonita Beach Rd SE Ste 200
Bonita Springs, FL 34135-4231
Phone (239) 537-2236

Other names 1

  • Mrs. Heather Wynn Randall Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Mar 11, 2026 through Mar 11, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
MH10531FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Progress Counseling, LLC Mental Health CurrentSince Nov 9, 2021 Accepting new patients

Locations

9200 Bonita Beach Rd SE
Ste 212
Bonita Springs, FL 34135
Phone (239) 537-2236

9220 Bonita Beach Rd SE
Ste 200
Bonita Springs, FL 34135
Phone (239) 537-2236

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1235606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1669612917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9220 BONITA BEACH RD SE STE 200",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354231",
            "telephone_number": "239-537-2236",
            "fax_number": "239-677-3025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9220 BONITA BEACH RD SE STE 200",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341354231",
            "telephone_number": "239-537-2236",
            "fax_number": "239-677-3025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "HEATHER",
        "middle_name": "ANNE",
        "name_prefix": "Ms.",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-26",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH10531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "RANDALL",
            "middle_name": "WYNN",
            "prefix": "MRS.",
            "credential": "LMHC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bonita Springs, FL

Sources for this page

Verify at the official NPI Registry.