Provider Demographics
NPI:1649208794
Name:LILLICH, CARLEEN FAITH (LPC)
Entity Type:Individual
Prefix:
First Name:CARLEEN
Middle Name:FAITH
Last Name:LILLICH
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 1:5871 PINE AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6545
Mailing Address - Country:US
Mailing Address - Phone:909-597-2226
Mailing Address - Fax:
Practice Address - Street 1:5871 PINE AVE STE 230
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6545
Practice Address - Country:US
Practice Address - Phone:909-597-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0807057101YM0800X, 101YP2500X
CA8382101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional