Provider Demographics
NPI:1093565509
Name:GAHAGAN, LILLIAN (LPCC)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:GAHAGAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2630
Mailing Address - Country:US
Mailing Address - Phone:516-413-7616
Mailing Address - Fax:
Practice Address - Street 1:2341 PINE ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4608
Practice Address - Country:US
Practice Address - Phone:516-413-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health