Healthcare Provider Details

I. General information

NPI: 1518283167
Provider Name (Legal Business Name): ANNETTE MARGUERITE WYNNE MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 DE SOTO AVE
WOODLAND HILLS CA
91367-6701
US

IV. Provider business mailing address

5601 DE SOTO AVE
WOODLAND HILLS CA
91367-6701
US

V. Phone/Fax

Practice location:
  • Phone: 877-608-0044
  • Fax: 877-608-0044
Mailing address:
  • Phone: 877-608-0044
  • Fax: 877-608-0044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number88585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: