MEDICARE: LILY LU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	82214	CA

General Provider Information

NPI Number	:	1255731907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY LU

Provider Business Mailing Address
First Line	:	1900 CAMDEN AVE STE 101
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2944
Country	:	US
Telephone Number	:	408-797-7067
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 CAMDEN AVE STE 101
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2944
Country	:	US
Telephone Number	:	408-797-7067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2014
Last Update Date	:	03/26/2021

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Directions to “ LILY LU ” Practice Location

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