Healthcare Provider Details

I. General information

NPI: 1659295228
Provider Name (Legal Business Name): EVAN LU AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N BROOKHURST ST STE 119
ANAHEIM CA
92801-5618
US

IV. Provider business mailing address

421 N BROOKHURST ST STE 119
ANAHEIM CA
92801-5618
US

V. Phone/Fax

Practice location:
  • Phone: 714-361-0898
  • Fax: 714-276-2604
Mailing address:
  • Phone: 714-361-0898
  • Fax: 714-276-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT164417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: