Healthcare Provider Details

I. General information

NPI: 1063657195
Provider Name (Legal Business Name): PAULA L WANG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 RIVER RD
EUGENE OR
97404-3242
US

IV. Provider business mailing address

2411 LENORE DR
EUGENE OR
97404-2397
US

V. Phone/Fax

Practice location:
  • Phone: 503-972-0235
  • Fax: 541-631-5114
Mailing address:
  • Phone: 503-304-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: