MEDICARE: SARAH MICHELLE WYNNE MA, LPCC, NCC

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	101Y00000X	Counselor		NM
2	247200000X	Other Technician
3	373H00000X	Day Training/Habilitation Specialist
4	101YM0800X	Mental Health Counselor	CMH0197821

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427393842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MICHELLE WYNNE MA, LPCC, NCC

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	:	505-980-5932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2012
Last Update Date	:	04/27/2023

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