Provider Demographics
NPI:1417492356
Name:WIN, WUT YI (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:WUT YI
Middle Name:
Last Name:WIN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17730 LASSEN ST
Mailing Address - Street 2:APT. 201
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4700
Mailing Address - Country:US
Mailing Address - Phone:818-671-9880
Mailing Address - Fax:
Practice Address - Street 1:17730 LASSEN ST
Practice Address - Street 2:APT. 201
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4700
Practice Address - Country:US
Practice Address - Phone:818-671-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-24779103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst