Provider Demographics
NPI:1437365491
Name:HIGDON, WENDY RAY (MFT)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:RAY
Last Name:HIGDON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2120 THIBODO COURT
Mailing Address - Street 2:SUITE 230
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7901
Mailing Address - Country:US
Mailing Address - Phone:858-279-1223
Mailing Address - Fax:760-597-4880
Practice Address - Street 1:2120 THIBODO COURT
Practice Address - Street 2:SUITE 230
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7901
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:760-597-4880
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist