Provider Demographics
NPI:1508005471
Name:LAU, ALFRED LIAT-KHOON (MA)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:LIAT-KHOON
Last Name:LAU
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 E 8600 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-6312
Mailing Address - Country:US
Mailing Address - Phone:801-561-9987
Mailing Address - Fax:801-561-9987
Practice Address - Street 1:575 23RD ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1539
Practice Address - Country:US
Practice Address - Phone:801-561-9987
Practice Address - Fax:801-561-9987
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6524478-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist