Individual
DR. BRIAN LICUANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
17 HERRINGBONE, IRVINE, CA 92620
(714) 469-1418
Mailing address
17 HERRINGBONE, IRVINE, CA 92620
(714) 469-1418
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
27276
CA
Other
Enumeration date
07/29/2015
Last updated
07/29/2015
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