Active NPI
Michelle Wong, LCSW
- Mental Health Counselor
- Los Angeles, CA
National Provider Identifier
1104411784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 124666
- Practice address
- 777 S Alameda St FL 2
Los Angeles, CA 90021-1656 - Phone
- (213) 289-3578
- Fax
- (213) 357-3667
- NPI assigned
- Mar 4, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 124666 | CA | |
| Mental Health Counselor | 101YM0800X | 124666 | CA | Primary |
Addresses
Primary practice location
777 S Alameda St FL 2
Los Angeles, CA 90021-1656
Mailing address
14377 Telluride Dr
Baldwin Park, CA 91706-5421
Phone (626) 384-7855
Other practice location 1
2116 Arlington Ave Ste 100
Los Angeles, CA 90018-1353
Phone (323) 334-9000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 124666 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sandbox Family Services | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722988800000",
"number": "1104411784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14377 TELLURIDE DR",
"city": "BALDWIN PARK",
"state": "CA",
"postal_code": "917065421",
"telephone_number": "626-384-7855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 S ALAMEDA ST FL 2",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900211656",
"telephone_number": "213-289-3578",
"fax_number": "213-357-3667"
}
],
"practiceLocations": [
{
"address_1": "2116 Arlington Ave Ste 100",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900181353",
"country_code": "US",
"telephone_number": "323-334-9000",
"fax_number": "323-334-4437",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WONG",
"first_name": "MICHELLE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-04",
"last_updated": "2024-08-07",
"certification_date": "2024-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "124666",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "124666",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.