Provider Demographics
NPI:1437270196
Name:LIEBHARD, JEAN M (LMFT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:LIEBHARD
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 1:1801 PARK COURT PL
Mailing Address - Street 2:SUITE F-103
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5002
Mailing Address - Country:US
Mailing Address - Phone:714-313-0402
Mailing Address - Fax:714-633-0850
Practice Address - Street 1:1801 PARK COURT PL
Practice Address - Street 2:SUITE F-103
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5002
Practice Address - Country:US
Practice Address - Phone:714-313-0402
Practice Address - Fax:714-633-0850
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA007773106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist