Provider Demographics
NPI:1154610673
Name:BROX, WENDY DENISE (LMFT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:DENISE
Last Name:BROX
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3134 WILLOW AVE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4747
Mailing Address - Country:US
Mailing Address - Phone:559-425-6640
Mailing Address - Fax:
Practice Address - Street 1:3134 WILLOW AVE
Practice Address - Street 2:SUITE #103
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4747
Practice Address - Country:US
Practice Address - Phone:559-425-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49402106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist