MEDICARE: DR. BETTY LUE LIEBER MS, PHD, MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LMFT 12760	CA
2	101YP2500X	Professional Counselor	LMFT 12760	CA
3	106H00000X	Marriage & Family Therapist	LMFT 12760	CA

General Provider Information

NPI Number	:	1457764466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTY LUE LIEBER MS, PHD, MFT

Provider Business Mailing Address
First Line	:	17664 GREENRIDGE RD
Second Line	:
City	:	HIDDEN VALLEY LAKE
State	:	CA
Zip	:	95467-8275
Country	:	US
Telephone Number	:	925-324-6030
Fax Number	:

Provider Business Practice Location Address
First Line	:	17664 GREENRIDGE RD
Second Line	:
City	:	HIDDEN VALLEY LAKE
State	:	CA
Zip	:	95467-8275
Country	:	US
Telephone Number	:	925-324-6030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2014
Last Update Date	:	06/06/2014

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