Provider Demographics
NPI:1245063627
Name:WANG, LI (LPC-T 04802)
Entity type:Individual
Prefix:
First Name:LI
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:LPC-T 04802
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W DOUGLAS AVE STE 625
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2917
Mailing Address - Country:US
Mailing Address - Phone:316-302-5083
Mailing Address - Fax:
Practice Address - Street 1:300 W DOUGLAS AVE STE 625
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2917
Practice Address - Country:US
Practice Address - Phone:316-302-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC-T04802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional