Provider Demographics
NPI:1447346119
Name:MOON, WENDY J (MA)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:J
Last Name:MOON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 EUREKA WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0223
Mailing Address - Country:US
Mailing Address - Phone:530-242-1941
Mailing Address - Fax:
Practice Address - Street 1:1560 MARKET ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1023
Practice Address - Country:US
Practice Address - Phone:530-225-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44752106H00000X
CA41641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist