Healthcare Provider Details

I. General information

NPI: 1942775853
Provider Name (Legal Business Name): SWEETWATER BEHAVIORAL HEALTH AND WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2018
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BEAVER ST
AMBRIDGE PA
15003-2487
US

IV. Provider business mailing address

618 BEAVER ST STE 200
SEWICKLEY PA
15143-1906
US

V. Phone/Fax

Practice location:
  • Phone: 412-347-1978
  • Fax:
Mailing address:
  • Phone: 412-347-1978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: WYNNE LUNDBLAD
Title or Position: PRESIDENT
Credential: MD
Phone: 412-347-1978