Healthcare Provider Details

I. General information

NPI: 1174404404
Provider Name (Legal Business Name): YUQI LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date: 05/04/2026
Reactivation Date: 08/31/2026

III. Provider practice location address

3130 LA SELVA STREET
SAN MATEO CA
94403
US

IV. Provider business mailing address

3130 LA SELVA ST
SAN MATEO CA
94403-2148
US

V. Phone/Fax

Practice location:
  • Phone: 617-277-8107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC23111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: