Healthcare Provider Details

I. General information

NPI: 1629625165
Provider Name (Legal Business Name): JOHN LIPTAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E BROADWAY STE 314
LONG BEACH CA
90802-7801
US

IV. Provider business mailing address

11 GOLDEN SHR STE 350
LONG BEACH CA
90802-4279
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-8995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number126186
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: