Individual
LI WAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 BEAR PL UNIT 97334, DEPT. OF PSYCHOLOGY, WACO, TX 76798-7334
(254) 710-2245
Mailing address
1 BEAR PL UNIT 97334, DEPT. OF PSYCHOLOGY, WACO, TX 76798-7334
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
Primary
19994211042230176010
ZZ
Other
Enumeration date
01/25/2010
Last updated
01/25/2010
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