MEDICARE: SARAH WYNNE COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1134744931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH WYNNE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	501 49TH ST NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-1621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 CANDELARIA RD NE STE 113
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1969
Country	:	US
Telephone Number	:	505-980-0171
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	SARAH MICHELLE WYNNE
Credential	:	MA, LPCC, NCC
Telephone Number	:	505-980-5932

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	04/27/2023

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