Basic Information
| Provider Information | |||||||||
| NPI: | 1326546938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIESS | ||||||||
| FirstName: | KIRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 37TH AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944034324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505732764 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 BREWSTER AVE | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503634111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2018 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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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 | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.