Healthcare Provider Details

I. General information

NPI: 1922781046
Provider Name (Legal Business Name): KELLY LIUFEN LIU PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18660 BAGLEY RD STE 101
MIDDLEBURG HEIGHTS OH
44130-3483
US

IV. Provider business mailing address

1374 E 31ST ST
CLEVELAND OH
44114-4025
US

V. Phone/Fax

Practice location:
  • Phone: 440-973-8400
  • Fax:
Mailing address:
  • Phone: 216-543-6261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023018844
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: