Provider Demographics
NPI:1952684995
Name:PAUL H WANG M DIV PH D & ASSOCIATES P C
Entity Type:Organization
Organization Name:PAUL H WANG M DIV PH D & ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-721-7777
Mailing Address - Street 1:225 S MERAMEC AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3511
Mailing Address - Country:US
Mailing Address - Phone:314-721-7777
Mailing Address - Fax:314-275-7773
Practice Address - Street 1:225 S MERAMEC AVE STE 213
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3511
Practice Address - Country:US
Practice Address - Phone:314-721-7777
Practice Address - Fax:314-275-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPSY R0220103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO498172006Medicaid
MO498172006Medicaid