Provider Demographics
NPI:1013246057
Name:WONG, LEE P (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:P
Last Name:WONG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12607 23RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6691
Mailing Address - Country:US
Mailing Address - Phone:415-577-2562
Mailing Address - Fax:
Practice Address - Street 1:12607 23RD AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6691
Practice Address - Country:US
Practice Address - Phone:415-577-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60537543103T00000X
CAPSY19830103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist