Provider Demographics
NPI:1669261418
Name:BRIGGS, WENDIE ANN
Entity type:Individual
Prefix:
First Name:WENDIE
Middle Name:ANN
Last Name:BRIGGS
Suffix:
Gender:
Credentials:
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 420924
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92142-0924
Mailing Address - Country:US
Mailing Address - Phone:314-779-4817
Mailing Address - Fax:
Practice Address - Street 1:10200 SEPULVEDA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-3316
Practice Address - Country:US
Practice Address - Phone:323-879-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15538101YM0800X
143921106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health