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General NPI Number Information
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NPI Number | 1952684995
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Entity Type | Organization
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Legal Business Name | PAUL H WANG M DIV PH D & ASSOCIATES P C
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Dates
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Enumeration Date | 09/26/2011
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 9666 OLIVE BLVD STE 510
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City | SAINT LOUIS
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State | MO
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Zip | 63132-3026
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Country | US
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Telephone | 314-721-7777
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Fax | 314-888-2610
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Provider Business Mailing Address
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Address Line | 9666 OLIVE BLVD STE 510
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City | SAINT LOUIS
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State | MO
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Zip | 63132-3026
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Country | US
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Telephone | 314-721-7777
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Fax | 314-888-2610
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL H. WANG
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Credential | PH.D.
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Telephone | 314-721-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY R0220
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License Number State | MO
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