Provider Demographics
NPI:1174653539
Name:CHANG, LILLIAN L (LMFT)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:L
Last Name:CHANG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92967
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91715-2967
Mailing Address - Country:US
Mailing Address - Phone:951-264-5496
Mailing Address - Fax:
Practice Address - Street 1:150 N GRAND AVE STE 212
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1757
Practice Address - Country:US
Practice Address - Phone:951-264-5496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist