Provider Demographics
NPI:1053938183
Name:BARILLAS, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BARILLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 EUREKA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3047
Mailing Address - Country:US
Mailing Address - Phone:916-780-1059
Mailing Address - Fax:916-780-1058
Practice Address - Street 1:1430 ALHAMBRA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6543
Practice Address - Country:US
Practice Address - Phone:916-780-1059
Practice Address - Fax:916-780-1058
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT119124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist