Provider Demographics
NPI:1124760897
Name:LIU, MING AN (MC, LAC)
Entity type:Individual
Prefix:
First Name:MING AN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MC, LAC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MC, LAC
Mailing Address - Street 1:510 S EXTENSION RD APT 2086
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2111 E BASELINE RD STE F8
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1519
Practice Address - Country:US
Practice Address - Phone:520-610-9736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health