Provider Demographics
NPI:1376980813
Name:TACKETT, LILIANA (MA)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:TACKETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LILIANA
Other - Middle Name:
Other - Last Name:FUNG LUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12220 113TH AVE NE STE 210
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6950
Mailing Address - Country:US
Mailing Address - Phone:206-925-3410
Mailing Address - Fax:
Practice Address - Street 1:12220 113TH AVE NE STE 210
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6950
Practice Address - Country:US
Practice Address - Phone:206-925-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61163819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist