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General NPI Number Information
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NPI Number | 1013658368
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Entity Type | Organization
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Legal Business Name | LILY PSYCHOLOGICAL CONSULTATION INC.
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 2183 W PASEO DEL MAR
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City | SAN PEDRO
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State | CA
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Zip | 90732-4556
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Country | US
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Telephone | 415-273-9233
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Fax |
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Provider Business Mailing Address
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Address Line | 454 LAS GALLINAS AVE # 1096
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3618
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Country | US
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Telephone | 415-273-9233
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. KATHERINE TAYLOR
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Credential | PSYD
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Telephone | 415-273-9233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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