Healthcare Provider Details

I. General information

NPI: 1265766729
Provider Name (Legal Business Name): XIAOLI WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E FLORIDA AVE
MIDLAND TX
79701-8212
US

IV. Provider business mailing address

PO BOX 5578
MIDLAND TX
79704-5578
US

V. Phone/Fax

Practice location:
  • Phone: 432-685-0450
  • Fax: 432-685-0459
Mailing address:
  • Phone: 432-570-0238
  • Fax: 432-699-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15742
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number81949
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: