Provider Demographics
NPI:1124548276
Name:HSU, CONNIE ANNE
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:ANNE
Last Name:HSU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 CAPRI CT
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4858
Mailing Address - Country:US
Mailing Address - Phone:310-923-6767
Mailing Address - Fax:
Practice Address - Street 1:18700 BEACH BLVD STE 160
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2073
Practice Address - Country:US
Practice Address - Phone:714-654-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist