Provider Demographics
NPI:1942775853
Name:SWEETWATER BEHAVIORAL HEALTH AND WELLNESS, PC
Entity Type:Organization
Organization Name:SWEETWATER BEHAVIORAL HEALTH AND WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDBLAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-347-1978
Mailing Address - Street 1:618 BEAVER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1906
Mailing Address - Country:US
Mailing Address - Phone:412-347-1978
Mailing Address - Fax:
Practice Address - Street 1:22 BEAVER ST
Practice Address - Street 2:
Practice Address - City:AMBRIDGE
Practice Address - State:PA
Practice Address - Zip Code:15003-2487
Practice Address - Country:US
Practice Address - Phone:412-347-1978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-06
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty