Provider Demographics
NPI:1558353573
Name:LILLIKER, SHELLEY L (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:L
Last Name:LILLIKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:SHELLEY
Other - Middle Name:L
Other - Last Name:BAILLARGEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:8245 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3356
Mailing Address - Country:US
Mailing Address - Phone:210-616-0022
Mailing Address - Fax:210-616-0258
Practice Address - Street 1:8245 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3356
Practice Address - Country:US
Practice Address - Phone:210-616-0022
Practice Address - Fax:210-616-0258
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX894101YM0800X
TX408106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist