Provider Demographics
NPI:1093260259
Name:BARNUM, LILLIANNE R (MA, LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:LILLIANNE
Middle Name:R
Last Name:BARNUM
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 39TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3414
Mailing Address - Country:US
Mailing Address - Phone:501-952-9188
Mailing Address - Fax:
Practice Address - Street 1:5426 CALIFORNIA AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1513
Practice Address - Country:US
Practice Address - Phone:206-409-3824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60689578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health