Provider Demographics
NPI:1508574872
Name:PARK, LILLIAN (LPC)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1494 WINDERMERE WAY
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1320
Mailing Address - Country:US
Mailing Address - Phone:469-951-5811
Mailing Address - Fax:
Practice Address - Street 1:3636 N MACARTHUR BLVD STE 160
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3601
Practice Address - Country:US
Practice Address - Phone:972-375-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional