Provider Demographics
NPI:1104461920
Name:LIEN LAC LMFT
Entity type:Organization
Organization Name:LIEN LAC LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-270-4199
Mailing Address - Street 1:428 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2637
Mailing Address - Country:US
Mailing Address - Phone:916-270-4199
Mailing Address - Fax:
Practice Address - Street 1:915 HIGHLAND POINTE DR STE 250
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5421
Practice Address - Country:US
Practice Address - Phone:510-599-8139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty