Provider Demographics
NPI:1861086670
Name:LI, JIA REBECCA (LMFT)
Entity type:Individual
Prefix:
First Name:JIA
Middle Name:REBECCA
Last Name:LI
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 1:3130 ALPINE ROAD
Mailing Address - Street 2:STE 288- 226
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028
Mailing Address - Country:US
Mailing Address - Phone:650-701-3123
Mailing Address - Fax:
Practice Address - Street 1:3130 ALPINE ROAD
Practice Address - Street 2:STE 288- 226
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028
Practice Address - Country:US
Practice Address - Phone:650-701-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119101106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist