Healthcare Provider Details

I. General information

NPI: 1417147570
Provider Name (Legal Business Name): ANITA MENG LIU MFT, PSYCH INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 E WALNUT ST
PASADENA CA
91107-3394
US

IV. Provider business mailing address

13218 BEACH ST
CERRITOS CA
90703-1330
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-5141
  • Fax:
Mailing address:
  • Phone: 562-229-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFT32400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: