Provider Demographics
NPI:1063622074
Name:LIEPMANN, TERRY W (MS LMFT)
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:W
Last Name:LIEPMANN
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 N OAKLAND AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1714
Mailing Address - Country:US
Mailing Address - Phone:626-584-4466
Mailing Address - Fax:626-584-5558
Practice Address - Street 1:180 N OAKLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1714
Practice Address - Country:US
Practice Address - Phone:626-584-4466
Practice Address - Fax:626-584-5558
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40546106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC40546OtherLICENSED MARRIAGE AND FAM