Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | CA | |
N | 103K00000X | Behavior Analyst | BCBA 1-14-9575 | |
Y | 102L00000X | Psychologist | LEP3560 | CA |
Y | 103T00000X | Psychologist | LEP3560 | CA |
NPI | 1003201187 |
---|---|
Provider Name | Wendela Marsh |
First Address | Merced, CA 95348-2155 |
Second Address | Merced, CA 95348-2155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2015 |
Last Update Date | 05/04/2015 |