Provider Demographics
NPI:1346525227
Name:ALLEN, WENDY (PHD MFT)
Entity Type:Individual
Prefix:MR
First Name:WENDY
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6835 FORTUNA RD
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-4314
Mailing Address - Country:US
Mailing Address - Phone:805-685-2212
Mailing Address - Fax:805-685-2212
Practice Address - Street 1:6835 FORTUNA RD.
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-4314
Practice Address - Country:US
Practice Address - Phone:805-962-2212
Practice Address - Fax:805-685-2212
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21158101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health