Provider Demographics
NPI:1780332585
Name:LAGREEN, WENDY DIANE (PSYD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:DIANE
Last Name:LAGREEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 N TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-2576
Mailing Address - Country:US
Mailing Address - Phone:714-926-3612
Mailing Address - Fax:
Practice Address - Street 1:218 E. MAIN STREET
Practice Address - Street 2:SUITE 202-B
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-926-3612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC1562101YM0800X
CAMFC49878106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health