Healthcare Provider Details

I. General information

NPI: 1174653539
Provider Name (Legal Business Name): LILLIAN L CHANG LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 S STATE COLLEGE BLVD STE 200
BREA CA
92821-5805
US

IV. Provider business mailing address

PO BOX 92967
CITY OF INDUSTRY CA
91715-2967
US

V. Phone/Fax

Practice location:
  • Phone: 951-264-5496
  • Fax:
Mailing address:
  • Phone: 951-264-5496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT46618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: