MEDICARE: PROF. LILLIE THI TRUONG

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	RBT2356	NV

General Provider Information

NPI Number	:	1720743891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. LILLIE THI TRUONG

Provider Business Mailing Address
First Line	:	1450 E HARMON AVE APT 117B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5946
Country	:	US
Telephone Number	:	512-748-0638
Fax Number	:

Provider Business Practice Location Address
First Line	:	3037 SOFT HORIZON WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1741
Country	:	US
Telephone Number	:	702-430-7660
Fax Number	:

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

Provider Enumeration Date	:	11/03/2021
Last Update Date	:	09/11/2025

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Directions to “ PROF. LILLIE THI TRUONG ” Practice Location

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