Provider Demographics
NPI:1548274426
Name:DWELLY, VERN LLOYD (MFT)
Entity type:Individual
Prefix:MR
First Name:VERN
Middle Name:LLOYD
Last Name:DWELLY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6067
Mailing Address - Country:US
Mailing Address - Phone:916-480-9807
Mailing Address - Fax:
Practice Address - Street 1:4921 KIPLING DR
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6067
Practice Address - Country:US
Practice Address - Phone:916-480-9807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist