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General NPI Number Information
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NPI Number | 1881502342
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Entity Type | Individual
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Provider Name | MARIAH NICHELLE WYNN
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Gender | Female
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 12669 ENCINITAS AVE
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City | SYLMAR
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State | CA
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Zip | 91342-3635
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Country | US
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Telephone | 800-700-8705
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Fax |
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Provider Business Mailing Address
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Address Line | 2225 E CESAR E CHAVEZ AVE # 1001
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City | LOS ANGELES
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State | CA
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Zip | 90033-1845
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Country | US
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Telephone |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 164963
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License Number State | CA
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