Provider Demographics
NPI:1710685714
Name:SUHANOVSKY, LILY
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:SUHANOVSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17980 SW KEMMER RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6078
Mailing Address - Country:US
Mailing Address - Phone:203-815-9576
Mailing Address - Fax:
Practice Address - Street 1:780 COMMERCIAL ST SE STE 104
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3465
Practice Address - Country:US
Practice Address - Phone:971-218-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health