Healthcare Provider Details

I. General information

NPI: 1306649025
Provider Name (Legal Business Name): CHRISTY ANN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WILLOW RD
MENLO PARK CA
94025-2619
US

IV. Provider business mailing address

3945 RIVERMARK PLZ # 1039
SANTA CLARA CA
95054-4156
US

V. Phone/Fax

Practice location:
  • Phone: 650-422-4022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number16983
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number148360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: