Healthcare Provider Details

I. General information

NPI: 1275315152
Provider Name (Legal Business Name): TABITHA WANG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 E GREEN ST STE 205
PASADENA CA
91101-5405
US

IV. Provider business mailing address

PO BOX 50004
PASADENA CA
91115-0004
US

V. Phone/Fax

Practice location:
  • Phone: 213-309-3302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: