Provider Demographics
NPI:1760969539
Name:SPREAD YOUR WINGS FOR MENTAL HEALTH INC
Entity Type:Organization
Organization Name:SPREAD YOUR WINGS FOR MENTAL HEALTH INC
Other - Org Name:ACCESS MENTAL HEALTH, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:SERRY
Authorized Official - Last Name:DUMBUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-401-2984
Mailing Address - Street 1:570 BLOSSOM HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3212
Mailing Address - Country:US
Mailing Address - Phone:855-799-4647
Mailing Address - Fax:
Practice Address - Street 1:570 BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3212
Practice Address - Country:US
Practice Address - Phone:855-799-4647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA336219OtherCA MEDICARE