Provider Demographics
NPI:1740540749
Name:HUYNH, LIA (MFT)
Entity type:Individual
Prefix:MRS
First Name:LIA
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:LIA
Other - Middle Name:
Other - Last Name:KOZUKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:545 LOS COCHES ST. #112
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035
Mailing Address - Country:US
Mailing Address - Phone:408-599-1413
Mailing Address - Fax:408-503-6176
Practice Address - Street 1:545 LOS COCHES ST. #112
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035
Practice Address - Country:US
Practice Address - Phone:408-599-1413
Practice Address - Fax:408-503-6176
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48711106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist