Provider Demographics
NPI:1659845105
Name:ROULEAU, LILLI (LMFT)
Entity Type:Individual
Prefix:
First Name:LILLI
Middle Name:
Last Name:ROULEAU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 OLIVE LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2101
Mailing Address - Country:US
Mailing Address - Phone:626-825-8387
Mailing Address - Fax:
Practice Address - Street 1:3715 MARKET ST STE 116
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-3469
Practice Address - Country:US
Practice Address - Phone:626-825-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92391106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist