Provider Demographics
NPI:1245342427
Name:LEWIS, WENDY ANN (MFT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 N SEPULVEDA BLVD
Mailing Address - Street 2:STE 30
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2948
Mailing Address - Country:US
Mailing Address - Phone:310-322-9889
Mailing Address - Fax:310-726-1111
Practice Address - Street 1:2100 N SEPULVEDA BLVD
Practice Address - Street 2:STE 30
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2948
Practice Address - Country:US
Practice Address - Phone:310-322-9889
Practice Address - Fax:310-726-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT33145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist