Provider Demographics
NPI:1740337583
Name:CONWAY, WENDY NADINE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:NADINE
Last Name:CONWAY
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 1:13420 MESA DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-8132
Mailing Address - Country:US
Mailing Address - Phone:530-917-5097
Mailing Address - Fax:
Practice Address - Street 1:356 PROVIDENCE MINE RD STE E
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2979
Practice Address - Country:US
Practice Address - Phone:530-917-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist