Provider Demographics
NPI:1437343894
Name:WONG, WESLEY WAYNE (MFTI)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:WAYNE
Last Name:WONG
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 E COOLEY DR STE 211
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3907
Mailing Address - Country:US
Mailing Address - Phone:909-429-3244
Mailing Address - Fax:909-981-0821
Practice Address - Street 1:1003 E COOLEY DR STE 211
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3907
Practice Address - Country:US
Practice Address - Phone:909-429-3244
Practice Address - Fax:909-981-0821
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA47847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program