Healthcare Provider Details

I. General information

NPI: 1477820561
Provider Name (Legal Business Name): SHIN-LU M LIU LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12826 SE 40TH LN SUITE 203
BELLEVUE WA
98006-4278
US

IV. Provider business mailing address

12826 SE 40TH LN SUITE 203
BELLEVUE WA
98006-4278
US

V. Phone/Fax

Practice location:
  • Phone: 425-449-8851
  • Fax:
Mailing address:
  • Phone: 425-449-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60232702
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: