Healthcare Provider Details

I. General information

NPI: 1134744931
Provider Name (Legal Business Name): SARAH WYNNE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 CANDELARIA RD NE STE 113
ALBUQUERQUE NM
87107-1969
US

IV. Provider business mailing address

501 49TH ST NW
ALBUQUERQUE NM
87105-1621
US

V. Phone/Fax

Practice location:
  • Phone: 505-980-0171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SARAH MICHELLE WYNNE
Title or Position: COUNSELOR
Credential: MA, LPCC, NCC
Phone: 505-980-5932