Provider Demographics
NPI:1891193439
Name:RICHARDSON, WENDY (LMFT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:RICHARDSON
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 1:3121 PARK AVE STE F
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2956
Mailing Address - Country:US
Mailing Address - Phone:831-479-4742
Mailing Address - Fax:831-464-1019
Practice Address - Street 1:3121 PARK AVE STE F
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2956
Practice Address - Country:US
Practice Address - Phone:831-479-4742
Practice Address - Fax:831-464-1019
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT021787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist