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NPI Code Detail

MEDICARE: DR. LAUREN LEE WING PH.D.

MEDICARE: DR. LAUREN LEE WING PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TB0200XCognitive & Behavioral Psychologist
2103TE1100XExercise & Sports Psychologist
3103TH0004XHealth Psychologist
4103TP2701XGroup Psychotherapy Psychologist
5103TC0700XClinical PsychologistPSY32797CA

General Provider Information

NPI Number : 1821223389
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAUREN LEE WING PH.D.
Provider Business Mailing Address
First Line : 3849 TILDEN AVE
Second Line : #4
City : CULVER CITY
State : CA
Zip : 90232-3946
Country : US
Telephone Number : 310-766-3240
Fax Number :
Provider Business Practice Location Address
First Line : 3831 HUGHES AVE STE 509
Second Line :
City : CULVER CITY
State : CA
Zip : 90232-6861
Country : US
Telephone Number : 424-284-2440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2009
Last Update Date : 09/13/2021

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