Provider Demographics
NPI:1790316156
Name:WENDT, WILLIAM TERRY
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TERRY
Last Name:WENDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 BREWER CIR
Mailing Address - Street 2:
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-2003
Mailing Address - Country:US
Mailing Address - Phone:850-426-1037
Mailing Address - Fax:
Practice Address - Street 1:4400 E HIGHWAY 20 STE 306
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-7703
Practice Address - Country:US
Practice Address - Phone:850-842-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist