Healthcare Provider Details

I. General information

NPI: 1063622074
Provider Name (Legal Business Name): TERRY W LIEPMANN MS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N OAKLAND AVE 2ND FLOOR
PASADENA CA
91101-1714
US

IV. Provider business mailing address

180 N OAKLAND AVE 2ND FLOOR
PASADENA CA
91101-1714
US

V. Phone/Fax

Practice location:
  • Phone: 626-584-4466
  • Fax: 626-584-5558
Mailing address:
  • Phone: 626-584-4466
  • Fax: 626-584-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC40546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: