Provider Demographics
NPI:1275684722
Name:WOHLBEG, JUDITH LOUISE (MFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LOUISE
Last Name:WOHLBEG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 CRESCENT WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6780
Mailing Address - Country:US
Mailing Address - Phone:707-825-8253
Mailing Address - Fax:707-825-0885
Practice Address - Street 1:801 CRESCENT WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6780
Practice Address - Country:US
Practice Address - Phone:707-825-8253
Practice Address - Fax:707-825-0885
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 19859106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist