Provider Demographics
NPI:1902952898
Name:PANAGOS, WENDY ANN (MFT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:PANAGOS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7339 EL CAJON BLVD
Mailing Address - Street 2:SUITE K
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941
Mailing Address - Country:US
Mailing Address - Phone:619-668-6200
Mailing Address - Fax:619-668-6202
Practice Address - Street 1:7339 EL CAJON BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941
Practice Address - Country:US
Practice Address - Phone:619-668-6200
Practice Address - Fax:619-668-6202
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist