Provider Demographics
NPI:1952409682
Name:ROZELLE, WENDY M (MA MFT)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:M
Last Name:ROZELLE
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23550 LYONS AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5745
Mailing Address - Country:US
Mailing Address - Phone:818-602-3680
Mailing Address - Fax:661-309-4677
Practice Address - Street 1:23550 LYONS AVE STE 211
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321
Practice Address - Country:US
Practice Address - Phone:818-602-3680
Practice Address - Fax:661-309-4677
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38131106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist