Provider Demographics
NPI:1962426718
Name:MILLER, WENDY S (MFT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21297 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-1554
Mailing Address - Country:US
Mailing Address - Phone:510-889-7300
Mailing Address - Fax:510-889-8359
Practice Address - Street 1:21297 FOOTHILL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-1554
Practice Address - Country:US
Practice Address - Phone:510-889-7300
Practice Address - Fax:510-889-8359
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 21680106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist