Healthcare Provider Details

I. General information

NPI: 1821223389
Provider Name (Legal Business Name): LAUREN LEE WING PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 HUGHES AVE STE 509
CULVER CITY CA
90232-6861
US

IV. Provider business mailing address

3849 TILDEN AVE #4
CULVER CITY CA
90232-3946
US

V. Phone/Fax

Practice location:
  • Phone: 424-284-2440
  • Fax:
Mailing address:
  • Phone: 310-766-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: