=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407589849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA J LIU LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2022
-----------------------------------------------------
Last Update Date | 07/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 326 S L ST
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-4412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-400-8047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 671 WINDMILL LN
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94566-7480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-400-8047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 133471
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------