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General NPI Number Information
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NPI Number | 1235904384
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Entity Type | Organization
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Legal Business Name | WYNNING FOUNDATION, INC.
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 5150 E PACIFIC COAST HWY STE 200
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City | LONG BEACH
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State | CA
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Zip | 90804-3399
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Country | US
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Telephone | 313-212-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 34830 FONTANA DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-5732
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Country | US
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Telephone | 313-212-7774
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PRESIDENT
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Name | WYNN ANTHONY SARDEN
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Credential |
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Telephone | 313-212-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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