Provider Demographics
NPI:1922558162
Name:DODGN, JUDY (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:DODGN
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 1:13025 BAILEY ST STE D
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4204
Mailing Address - Country:US
Mailing Address - Phone:562-881-7801
Mailing Address - Fax:
Practice Address - Street 1:13025 BAILEY ST STE D
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4204
Practice Address - Country:US
Practice Address - Phone:562-881-7801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist