Provider Demographics
NPI:1831738640
Name:WONG, STANLEY SHAWN (AMFT)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:SHAWN
Last Name:WONG
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 OHIO AVE APT F
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-1016
Mailing Address - Country:US
Mailing Address - Phone:626-348-6730
Mailing Address - Fax:
Practice Address - Street 1:2248 OBISPO AVE STE 202
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-4026
Practice Address - Country:US
Practice Address - Phone:224-820-2907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist