MEDICARE: SUZANNE BERTHOLIC-LILJENBERG LMHCA

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	MC60978464	WA

General Provider Information

NPI Number	:	1649031766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE BERTHOLIC-LILJENBERG LMHCA

Provider Business Mailing Address
First Line	:	11711 E SPRAGUE AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11711 E SPRAGUE AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-6126
Country	:	US
Telephone Number	:	509-927-6838
Fax Number	:

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

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	01/16/2024

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