Provider Demographics
NPI:1679764971
Name:SHIPLEY, LILLIAN LOREEN (PHD,)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:LOREEN
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 W ACOMA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4403
Mailing Address - Country:US
Mailing Address - Phone:602-938-1985
Mailing Address - Fax:602-938-7705
Practice Address - Street 1:5400 W NORTHERN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1406
Practice Address - Country:US
Practice Address - Phone:602-978-9424
Practice Address - Fax:602-938-7705
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0945103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist