Healthcare Provider Details

I. General information

NPI: 1043144298
Provider Name (Legal Business Name): LIBERTY THROUGH THERAPY PROFESSIONAL CLINICAL COUNSELOR, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 BOREL PL STE 400
SAN MATEO CA
94402-3513
US

IV. Provider business mailing address

1777 BOREL PL STE 400
SAN MATEO CA
94402-3513
US

V. Phone/Fax

Practice location:
  • Phone: 415-429-6130
  • Fax: 855-229-3626
Mailing address:
  • Phone: 415-429-6130
  • Fax: 855-229-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MINJUN WANG
Title or Position: CEO / OWNER
Credential: LPCC
Phone: 415-429-6130