Healthcare Provider Details

I. General information

NPI: 1134244593
Provider Name (Legal Business Name): CHRISTY WANG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 GUADALUPE PKWY
SAN JOSE CA
95110-1714
US

IV. Provider business mailing address

455 FOLSOM CIR
MILPITAS CA
95035-3538
US

V. Phone/Fax

Practice location:
  • Phone: 408-299-3166
  • Fax: 408-971-2651
Mailing address:
  • Phone: 408-945-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 26038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: