Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ASW102748 | CA |
N | 106S00000X | Behavior Technician | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1003386699 |
---|---|
Provider Name | Minyu Liao |
First Address | Modesto, CA 95355-1582 |
Second Address | Rosemead, CA 91770-1923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2018 |
Last Update Date | 27/09/2021 |