Provider Demographics
NPI:1518007293
Name:WONG, IRIS LAI (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:LAI
Last Name:WONG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14712 PIPELINE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1298
Mailing Address - Country:US
Mailing Address - Phone:909-497-0318
Mailing Address - Fax:
Practice Address - Street 1:14712 PIPELINE AVE STE B
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1298
Practice Address - Country:US
Practice Address - Phone:909-497-0318
Practice Address - Fax:909-606-8855
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT40891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist