Provider Demographics
NPI:1437423852
Name:LIEFER, ANTHONY D (MFT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:D
Last Name:LIEFER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 SHADY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3725
Mailing Address - Country:US
Mailing Address - Phone:619-379-4513
Mailing Address - Fax:
Practice Address - Street 1:4455 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CRP CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5101
Practice Address - Country:US
Practice Address - Phone:619-379-4513
Practice Address - Fax:361-814-2274
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201816101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health