Provider Demographics
NPI:1306236351
Name:LIU, GRACE CHI SHAN (PSY D, LMFT 77513)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:CHI SHAN
Last Name:LIU
Suffix:
Gender:F
Credentials:PSY D, LMFT 77513
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219B OCEAN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4717
Mailing Address - Country:US
Mailing Address - Phone:310-570-0277
Mailing Address - Fax:
Practice Address - Street 1:1219B OCEAN PARK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-4717
Practice Address - Country:US
Practice Address - Phone:310-570-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist