Provider Demographics
NPI:1669863056
Name:KRISTIN A. LIANG, PH.D. PROFESSIONAL PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:KRISTIN A. LIANG, PH.D. PROFESSIONAL PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-339-0288
Mailing Address - Street 1:500 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3762
Mailing Address - Country:US
Mailing Address - Phone:626-339-0288
Mailing Address - Fax:626-339-2248
Practice Address - Street 1:500 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3762
Practice Address - Country:US
Practice Address - Phone:626-339-0288
Practice Address - Fax:626-339-2248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-07
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22902103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY229020Medicaid
CADC303AMedicare UPIN