Provider Demographics
NPI:1588896427
Name:LIU, JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BLAZING STAR ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2788
Mailing Address - Country:US
Mailing Address - Phone:414-791-5979
Mailing Address - Fax:
Practice Address - Street 1:220 9TH ST
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456
Practice Address - Country:US
Practice Address - Phone:850-229-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist