Provider Demographics
NPI:1326593856
Name:LU, MICHAEL PHILLIP (BA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PHILLIP
Last Name:LU
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11277 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1340
Mailing Address - Country:US
Mailing Address - Phone:714-620-8131
Mailing Address - Fax:
Practice Address - Street 1:11277 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1340
Practice Address - Country:US
Practice Address - Phone:714-620-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101-YM0800XOtherTAXONOMY