Provider Demographics
NPI:1376029264
Name:SHIH, LILY WEN (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:LILY
Middle Name:WEN
Last Name:SHIH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5369 INGLEWOOD BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5956
Mailing Address - Country:US
Mailing Address - Phone:661-205-3823
Mailing Address - Fax:
Practice Address - Street 1:5369 INGLEWOOD BLVD APT 3
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5956
Practice Address - Country:US
Practice Address - Phone:661-205-3823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-14
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst