1336301621 NPI number — DR. SHANNON M LILJA DBH LPC LMHC CDP CAD

Table of content: DR. SHANNON M LILJA DBH LPC LMHC CDP CAD (NPI 1336301621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336301621 NPI number — DR. SHANNON M LILJA DBH LPC LMHC CDP CAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LILJA
Provider First Name:
SHANNON
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DBH LPC LMHC CDP CAD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336301621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 177
Provider Second Line Business Mailing Address:
SANDALWOOD COUNSELING LLC
Provider Business Mailing Address City Name:
SKAMOKAWA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-260-5118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
818 COMMERCIAL ST STE 305
Provider Second Line Business Practice Location Address:
(SECOND OFFICE IN BEAVERTON, OREGON)
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97103-4553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-260-5118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  RC60020400 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: RC60020400 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: RC60020400 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: RC60020400 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: RC60020400 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)