MEDICARE: WENDY ALT MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	104707	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912301318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY ALT MFT

Provider Business Mailing Address
First Line	:	8613 MCATEE ST
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-8761
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	891 MOUNTAIN RANCH RD
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-9713
Country	:	US
Telephone Number	:	209-754-6843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2014
Last Update Date	:	03/19/2026

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