Healthcare Provider Details

I. General information

NPI: 1154839629
Provider Name (Legal Business Name): JOY LIU LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 12/09/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11429 VALLEY BLVD
EL MONTE CA
91731-3229
US

IV. Provider business mailing address

1339 E LOMA VISTA ST
WEST COVINA CA
91790-1825
US

V. Phone/Fax

Practice location:
  • Phone: 909-358-7950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: