Basic Information
| Provider Information | |||||||||
| NPI: | 1821223389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WING | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3849 TILDEN AVE | ||||||||
| Address2: | #4 | ||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902323946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107663240 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3831 HUGHES AVE STE 509 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902326861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242842440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2009 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TE1100X | N | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports | 103TH0004X | N | Behavioral Health & Social Service Providers | Psychologist | Health | 103TP2701X | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 103TC0700X | PSY32797 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.