Healthcare Provider Details

I. General information

NPI: 1063056166
Provider Name (Legal Business Name): LAUREN LIU MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date: 04/20/2022
Reactivation Date: 06/03/2022

III. Provider practice location address

211 IMPERIAL HWY STE 105
FULLERTON CA
92835-1047
US

IV. Provider business mailing address

408 VIOLETA LN
BREA CA
92823-6371
US

V. Phone/Fax

Practice location:
  • Phone: 949-610-8966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLPC004501
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: