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General NPI Number Information
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NPI Number | 1760969539
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Entity Type | Organization
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Legal Business Name | SPREAD YOUR WINGS FOR MENTAL HEALTH INC
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 10/22/2021
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Provider Practice Location Address
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Address Line | 570 BLOSSOM HILL RD
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City | SAN JOSE
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State | CA
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Zip | 95123-3212
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Country | US
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Telephone | 855-799-4647
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Fax |
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Provider Business Mailing Address
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Address Line | 570 BLOSSOM HILL RD
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City | SAN JOSE
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State | CA
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Zip | 95123-3212
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Country | US
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Telephone | 855-799-4647
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANDREW SERRY DUMBUYA
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Credential |
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Telephone | 408-401-2984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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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 #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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