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General NPI Number Information
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NPI Number | 1487509402
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Entity Type | Organization
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Legal Business Name | LILAC DEVELOPMENTAL HEALTH LLC
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 4036 SHADOW OAK CT
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City | FENTON
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State | MI
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Zip | 48430-9122
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Country | US
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Telephone | 989-854-4273
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Fax |
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Provider Business Mailing Address
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Address Line | 4036 SHADOW OAK CT
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City | FENTON
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State | MI
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Zip | 48430-9122
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | MRS. AUDREY L KORESH
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Credential | MA, BCBA, LBA
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Telephone | 989-854-4273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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