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General NPI Number Information
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NPI Number | 1306333935
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Entity Type | Organization
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Legal Business Name | BETH LILJESTRAND
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3201 SHAMROCK ST S STE 103
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City | TALLAHASSEE
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State | FL
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Zip | 32309-3349
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Country | US
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Telephone | 850-661-5466
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Fax | 850-894-0062
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Provider Business Mailing Address
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Address Line | 3201 SHAMROCK ST S STE 103
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City | TALLAHASSEE
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State | FL
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Zip | 32309-3349
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Country | US
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Telephone | 850-661-5466
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Fax | 850-894-0062
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Authorized Official
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Title or Position | THERAPIST/PRIVATE PRACTITIONER
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Name | MRS. BETH ANN LILJESTRAND
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Credential | LMHC
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Telephone | 850-661-5466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 7203
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License Number State | FL
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