Active NPI
Li Wan
- Psychologist
- Waco, TX
National Provider Identifier
1619208048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 19994211042230176010
- Practice address
- 1 Bear PL Unit 97334
Dept. of Psychology
Waco, TX 76798-7334 - Phone
- (254) 710-2245
- NPI assigned
- Jan 25, 2010
- 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 |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Psychologist | 103T00000X | 19994211042230176010 | ZZ | Primary |
Addresses
Primary practice location
1 Bear PL Unit 97334
Dept. of Psychology
Waco, TX 76798-7334
Mailing address
1 Bear PL Unit 97334
Dept. of Psychology
Waco, TX 76798-7334
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 |
|---|---|---|---|
| 19994211042230176010 | ZZ | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264377600000",
"number": "1619208048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 BEAR PL UNIT 97334",
"address_2": "DEPT. OF PSYCHOLOGY",
"city": "WACO",
"state": "TX",
"postal_code": "767987334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BEAR PL UNIT 97334",
"address_2": "DEPT. OF PSYCHOLOGY",
"city": "WACO",
"state": "TX",
"postal_code": "767987334",
"telephone_number": "254-710-2245"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAN",
"first_name": "LI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-25",
"last_updated": "2010-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ZZ",
"license": "19994211042230176010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.