Healthcare Provider Details

I. General information

NPI: 1831419704
Provider Name (Legal Business Name): WANYU CHANG PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 E UNION ST STE 202
PASADENA CA
91106-1782
US

IV. Provider business mailing address

940 E UNION ST STE 202
PASADENA CA
91106-1782
US

V. Phone/Fax

Practice location:
  • Phone: 626-872-5718
  • Fax:
Mailing address:
  • Phone: 626-872-5718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26831
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: