Basic Information
Provider Information
NPI: 1003001306
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIAW-GRAY
FirstName: JANE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PSYD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 410 BELLEVUE WAY SE
Address2: SUITE 303
City: BELLEVUE
State: WA
PostalCode: 980046672
CountryCode: US
TelephoneNumber: 4256108234
FaxNumber:  
Practice Location
Address1: 410 BELLEVUE WAY SE
Address2: SUITE 303
City: BELLEVUE
State: WA
PostalCode: 980046672
CountryCode: US
TelephoneNumber: 4256108234
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/10/2007
LastUpdateDate: 03/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XPY60546231WAY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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