Provider Demographics
NPI:1588329981
Name:LI, JIEXUAN (LMHC)
Entity type:Individual
Prefix:
First Name:JIEXUAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WASHINGTON BLVD APT 3002
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2027
Mailing Address - Country:US
Mailing Address - Phone:646-298-2751
Mailing Address - Fax:
Practice Address - Street 1:885 N SAN ANTONIO RD STE O
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1341
Practice Address - Country:US
Practice Address - Phone:650-434-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011279-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health