Provider Demographics
NPI:1801906367
Name:WONG, SANDY (LPC)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BRANARD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006
Mailing Address - Country:US
Mailing Address - Phone:713-529-0037
Mailing Address - Fax:713-526-4367
Practice Address - Street 1:401 BRANARD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006
Practice Address - Country:US
Practice Address - Phone:713-529-0037
Practice Address - Fax:713-526-4367
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 101YP2500X
TX19122101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1694053-01Medicaid
TX169485302Medicaid