Provider Demographics
NPI:1528592052
Name:WINGERT, DAWN M (LMFT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:WINGERT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66891
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95067-6891
Mailing Address - Country:US
Mailing Address - Phone:831-824-4194
Mailing Address - Fax:
Practice Address - Street 1:5521 SCOTTS VALLEY DR STE 240
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3471
Practice Address - Country:US
Practice Address - Phone:831-824-4194
Practice Address - Fax:831-295-5583
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist