Provider Demographics
NPI:1013658368
Name:LILY PSYCHOLOGICAL CONSULTATION INC.
Entity Type:Organization
Organization Name:LILY PSYCHOLOGICAL CONSULTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-273-9233
Mailing Address - Street 1:454 LAS GALLINAS AVE # 1096
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3618
Mailing Address - Country:US
Mailing Address - Phone:415-273-9233
Mailing Address - Fax:
Practice Address - Street 1:2183 W PASEO DEL MAR
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-4556
Practice Address - Country:US
Practice Address - Phone:415-273-9233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty