Provider Demographics
NPI:1851534507
Name:WYNNE, PATRICIA (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:WYNNE
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:WYNNE-SORLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LMFT
Mailing Address - Street 1:PO BOX 1624
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90742-1624
Mailing Address - Country:US
Mailing Address - Phone:818-648-4566
Mailing Address - Fax:562-592-1791
Practice Address - Street 1:18600 MAIN ST
Practice Address - Street 2:SUITE # 295
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1708
Practice Address - Country:US
Practice Address - Phone:562-592-1231
Practice Address - Fax:562-592-1791
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC13026106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist