Wendy Rae Dwan

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LAC-19109 Issued in AZ

Practice address

1580 N Kolb Rd Ste 100
Tucson, AZ 85715-4932

Phone

(520) 214-8650

NPI assigned

Mar 14, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 23, 2026 through Feb 23, 2028

Medicare enrollment (NPD)

Not enrolled

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.

• Soul Space, LLC

  • Community/Behavioral Health Agency
  • Tucson, AZ
  • NPI 1871135335
  NPD

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

{
    "created_epoch": "1678752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1790486900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1580 N KOLB RD STE 100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857154932",
            "telephone_number": "520-214-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1580 N KOLB RD STE 100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857154932",
            "telephone_number": "520-214-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DWAN",
        "first_name": "WENDY",
        "middle_name": "RAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-14",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LAC-19109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dva Renal Healthcare Inc
• Keith R Dveirin, MD
• Sydni A Dvorak, DNP, NP
• Jennifer Dvoskin, PSY.D.
• Veronica Lynn Dvoskin, RN
• Dan Dwarka, M.D.
• Andrew Tealey Dwenger, PHARMD
• Holly Dwyer, PTA
• Albert Dy
• Kensey Lynn Jamison Dye

• Mental Health Counselor in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.