Individual provider Active NPI

Mariah Nichelle Wynn

  • Marriage & Family Therapist
  • Sylmar, CA
National Provider Identifier
1881502342
Registry record updated Aug 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
164963 Issued in CA
Practice address
12669 Encinitas Ave
Sylmar, CA 91342-3635
Phone
(800) 700-8705
NPI assigned
Aug 27, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 164963 CA Primary

Addresses

Primary practice location

12669 Encinitas Ave
Sylmar, CA 91342-3635

Mailing address

2225 E Cesar E Chavez Ave # 1001
Los Angeles, CA 90033-1845

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1787788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1881502342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 E CESAR E CHAVEZ AVE # 1001",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900331845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12669 ENCINITAS AVE",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913423635",
            "telephone_number": "800-700-8705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "MARIAH",
        "middle_name": "NICHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-08-27",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "164963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylmar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.