Provider Demographics
NPI:1386886174
Name:LIU, INC., JUDY A
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:A
Last Name:LIU, INC.
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:A
Other - Last Name:LIU, INC.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3669 MIRA PACIFIC DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3954
Mailing Address - Country:US
Mailing Address - Phone:760-518-9242
Mailing Address - Fax:
Practice Address - Street 1:3669 MIRA PACIFIC DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3954
Practice Address - Country:US
Practice Address - Phone:760-518-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31687106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist