Provider Demographics
NPI:1750623286
Name:WONG, AMY ELISE (LMFT, LCDC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELISE
Last Name:WONG
Suffix:
Gender:F
Credentials:LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14927 KIMBERLEY LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-4503
Mailing Address - Country:US
Mailing Address - Phone:832-794-8667
Mailing Address - Fax:
Practice Address - Street 1:14133 MEMORIAL DR STE 6
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-6800
Practice Address - Country:US
Practice Address - Phone:713-234-0289
Practice Address - Fax:281-916-4454
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3311106H00000X
TX202008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist