Provider Demographics
NPI:1811122179
Name:CHANG, WONDRA (LPC)
Entity type:Individual
Prefix:MS
First Name:WONDRA
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:WONDRA
Other - Middle Name:
Other - Last Name:BILBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7709 BROADWAY ST.
Mailing Address - Street 2:#115
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-385-2639
Mailing Address - Fax:
Practice Address - Street 1:7709 BROADWAY ST.
Practice Address - Street 2:#115
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-385-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14563(LPC)101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113113801Medicaid