MEDICARE: MR. JACOB WILLIAM LILLEY M.A., BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1215444617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB WILLIAM LILLEY M.A., BCBA

Provider Business Mailing Address
First Line	:	2450 VENTURE OAKS WAY STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-4226
Country	:	US
Telephone Number	:	916-812-5438
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 VENTURE OAKS WAY STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-4226
Country	:	US
Telephone Number	:	916-812-5438
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2018
Last Update Date	:	01/07/2026

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