Provider Demographics
NPI:1619709011
Name:WONG, PIK CHING (LPC)
Entity type:Individual
Prefix:
First Name:PIK CHING
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-0261
Mailing Address - Country:US
Mailing Address - Phone:208-505-9990
Mailing Address - Fax:
Practice Address - Street 1:151 N 3RD AVE STE 101
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6367
Practice Address - Country:US
Practice Address - Phone:208-505-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-10574101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor