Provider Demographics
NPI:1952060105
Name:SIU, LORREN GABRIELLE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LORREN
Middle Name:GABRIELLE
Last Name:SIU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14639 BIG BASIN WAY STE C
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6081
Mailing Address - Country:US
Mailing Address - Phone:408-418-8285
Mailing Address - Fax:
Practice Address - Street 1:14639 BIG BASIN WAY STE C
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6081
Practice Address - Country:US
Practice Address - Phone:408-418-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist