Provider Demographics
NPI:1568507382
Name:ORTIZ-SELF, LILLIAN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:
Last Name:ORTIZ-SELF
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1921
Mailing Address - Country:US
Mailing Address - Phone:425-232-6615
Mailing Address - Fax:
Practice Address - Street 1:3114 OAKES AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4406
Practice Address - Country:US
Practice Address - Phone:425-232-6615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health