Healthcare Provider Details

I. General information

NPI: 1255813275
Provider Name (Legal Business Name): CHIA-JU CHARLOTTE LIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLOTTE LIN ESQ

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18623 GALE AVE STE 154
CITY OF INDUSTRY CA
91748-1342
US

IV. Provider business mailing address

18623 GALE AVE STE 154
CITY OF INDUSTRY CA
91748-1342
US

V. Phone/Fax

Practice location:
  • Phone: 626-248-1800
  • Fax:
Mailing address:
  • Phone: 626-839-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT117928
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT159424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: