Provider Demographics
NPI:1912243791
Name:WONG, SAYULI S (PSYD)
Entity Type:Individual
Prefix:
First Name:SAYULI
Middle Name:S
Last Name:WONG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 BUTTE HOUSE ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993
Mailing Address - Country:US
Mailing Address - Phone:530-671-5483
Mailing Address - Fax:
Practice Address - Street 1:1585 BUTTE HOUSE RD.
Practice Address - Street 2:SUITE C
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993
Practice Address - Country:US
Practice Address - Phone:530-671-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-22
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25264103TA0400X, 103TA0700X, 103TC0700X, 103TF0000X, 103TC2200X, 103TB0200X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst