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General NPI Number Information
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NPI Number | 1174936827
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Entity Type | Individual
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Provider Name | MICHAEL WYNDHAM RIDGWAY LPCC
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Gender | Male
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 365 STOWELL AVE
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City | SUNNYVALE
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State | CA
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Zip | 94085-4316
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Country | US
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Telephone | 408-829-2326
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Fax |
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Provider Business Mailing Address
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Address Line | 209 E JAVA DR UNIT 62513
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City | SUNNYVALE
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State | CA
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Zip | 94088-8026
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Country | US
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Telephone | 408-701-7722
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5977
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License Number State | CA
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