Provider Demographics
NPI:1174090831
Name:EMERSON, WENDY (AMFT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:EMERSON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6444 E SPRING ST STE 283
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1553
Mailing Address - Country:US
Mailing Address - Phone:714-270-1474
Mailing Address - Fax:
Practice Address - Street 1:9015 MURRAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3617
Practice Address - Country:US
Practice Address - Phone:408-842-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91022106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA91022OtherBOARD OF BEHAVIORAL SCIENCES OF CALIFORNIA