Healthcare Provider Details

I. General information

NPI: 1639759756
Provider Name (Legal Business Name): WENDY COLLEEN WILFERT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25401 CABOT RD STE 116
LAGUNA HILLS CA
92653-5530
US

IV. Provider business mailing address

PO BOX 114
DANA POINT CA
92629-0114
US

V. Phone/Fax

Practice location:
  • Phone: 949-903-0764
  • Fax:
Mailing address:
  • Phone: 949-903-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number41014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: