Provider Demographics
NPI:1326591090
Name:LEAD WAY BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:LEAD WAY BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LI WEI
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D
Authorized Official - Phone:626-374-0306
Mailing Address - Street 1:177 E COLORADO BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1986
Mailing Address - Country:US
Mailing Address - Phone:626-374-0306
Mailing Address - Fax:
Practice Address - Street 1:177 E COLORADO BLVD # 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1986
Practice Address - Country:US
Practice Address - Phone:626-374-0306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health