Provider Demographics
NPI:1700614963
Name:FISHBURNE, WENDY (LMFT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:FISHBURNE
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 1:104 S FREYA ST STE 214A
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-6204
Mailing Address - Country:US
Mailing Address - Phone:509-795-0460
Mailing Address - Fax:509-940-0048
Practice Address - Street 1:104 S FREYA ST STE 214A
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-6204
Practice Address - Country:US
Practice Address - Phone:509-795-0460
Practice Address - Fax:509-940-0048
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61455003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist