Provider Demographics
NPI:1972797660
Name:WIELENGA, LATEEFH (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:LATEEFH
Middle Name:
Last Name:WIELENGA
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 JULIAN AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3111
Mailing Address - Country:US
Mailing Address - Phone:562-895-0516
Mailing Address - Fax:562-684-0113
Practice Address - Street 1:3531 JULIAN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3111
Practice Address - Country:US
Practice Address - Phone:562-895-0516
Practice Address - Fax:562-684-0113
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist