Provider Demographics
NPI:1790231108
Name:WONG, YOSHIE (MFT)
Entity Type:Individual
Prefix:MS
First Name:YOSHIE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:YOSHIE
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:673 WOODLAND SQUARE LOOP SE STE 330
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1066
Mailing Address - Country:US
Mailing Address - Phone:888-364-5977
Mailing Address - Fax:360-628-5240
Practice Address - Street 1:673 WOODLAND SQUARE LOOP SE STE 330
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1066
Practice Address - Country:US
Practice Address - Phone:888-364-5977
Practice Address - Fax:360-628-5240
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 00001293106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist