Healthcare Provider Details

I. General information

NPI: 1568255073
Provider Name (Legal Business Name): LILY CHA MS, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 ROBERTS LN STE A
BAKERSFIELD CA
93308-4723
US

IV. Provider business mailing address

661 ROBERTS LN STE A
BAKERSFIELD CA
93308-4723
US

V. Phone/Fax

Practice location:
  • Phone: 661-371-3360
  • Fax:
Mailing address:
  • Phone: 661-371-3360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number142803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: