Provider Demographics
NPI:1164671616
Name:XI, LIEN PHAM
Entity Type:Individual
Prefix:
First Name:LIEN
Middle Name:PHAM
Last Name:XI
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 1:500 JEFFERSON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95605
Mailing Address - Country:US
Mailing Address - Phone:530-601-5959
Mailing Address - Fax:916-504-4319
Practice Address - Street 1:500 JEFFERSON BLVD STE B
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605
Practice Address - Country:US
Practice Address - Phone:530-604-5959
Practice Address - Fax:916-504-4319
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 89350106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist