Healthcare Provider Details

I. General information

NPI: 1619462504
Provider Name (Legal Business Name): PEI-HSUAN LIU LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 N ATHERTON ST # 4
STATE COLLEGE PA
16803-1544
US

IV. Provider business mailing address

425 WAUPELANI DR APT 122
STATE COLLEGE PA
16801-4542
US

V. Phone/Fax

Practice location:
  • Phone: 814-237-0567
  • Fax: 814-237-0569
Mailing address:
  • Phone: 814-777-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010499
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: