Spread Your Wings for Mental Health Inc

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

SPREAD YOUR WINGS FOR MENTAL HEALTH INC

Doing business as

ACCESS Mental Health, Inc

Practice address

570 Blossom Hill Rd
San Jose, CA 95123-3212

Phone

(855) 799-4647

NPI assigned

Jul 25, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrew Serry Dumbuya

Title

Ceo

Phone

(408) 401-2984

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• ACCESS Mental Health, Inc Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wen Fan, M.A.

  • Marriage & Family Therapist
  • San Jose, CA
  • NPI 1932486172

  Counselor

  Medicare reassignment NPD
• Kelsey Shawn Keane

  • Clinical Social Worker
  • Oakland, CA
  • NPI 1174017131

  Mental Health

  Medicare reassignment NPD
• Vivian Figueroa Kelly

  • Mental Health Counselor
  • Los Gatos, CA
  • NPI 1093190498
  Medicare reassignment
• Serry Dumbuya

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1710202155
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634860800000",
    "number": "1760969539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 BLOSSOM HILL RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951233212",
            "telephone_number": "855-799-4647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 BLOSSOM HILL RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951233212",
            "telephone_number": "855-799-4647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPREAD YOUR WINGS FOR MENTAL HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-25",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A",
        "authorized_official_last_name": "DUMBUYA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "SERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "408-401-2984"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA MEDICARE",
            "identifier": "CA336219",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsuh@sywca.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "570 Blossom Hill Rd",
            "city": "San Jose",
            "state": "CA",
            "country_code": "US",
            "postal_code": "951233212",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ACCESS Mental Health, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychiatry Physician in San Jose, CA
• Providers in San Jose, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.