Healthcare Provider Details

I. General information

NPI: 1760835821
Provider Name (Legal Business Name): JANET LY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 SARATOGA AVE STE 14
SAN JOSE CA
95129
US

IV. Provider business mailing address

PO BOX 22344
SAN JOSE CA
95151-2344
US

V. Phone/Fax

Practice location:
  • Phone: 408-996-7950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number106716
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number91981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: