Basic Information
| Provider Information | |||||||||
| NPI: | 1003148131 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUCKINGHAM | ||||||||
| FirstName: | WENDY | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 6TH ST | ||||||||
| Address2: | #101A-141 | ||||||||
| City: | NORCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928601472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609871680 | ||||||||
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| Practice Location | |||||||||
| Address1: | 960 6TH ST | ||||||||
| Address2: | #101A-141 | ||||||||
| City: | NORCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928601472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609871680 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2010 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT 84548 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.