Provider Demographics
NPI:1366842114
Name:LIN, CHIENYU
Entity type:Individual
Prefix:
First Name:CHIENYU
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14435 S 48TH ST APT 2174
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6443
Mailing Address - Country:US
Mailing Address - Phone:626-537-9702
Mailing Address - Fax:
Practice Address - Street 1:11800 CENTRAL AVE STE 225
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-7201
Practice Address - Country:US
Practice Address - Phone:626-515-6008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AZ16261106H00000X
TX204635106H00000X
CA108255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst