Basic Information
| Provider Information | |||||||||
| NPI: | 1124269949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LU | ||||||||
| FirstName: | JANE | ||||||||
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| Credential: | MFT-INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12125 179TH ST | ||||||||
| Address2: | |||||||||
| City: | ARTESIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907014130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629248168 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11050 ARTESIA BLVD STE F | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628608838 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2009 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | MFT92656 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.