Provider Demographics
NPI:1336236926
Name:HUGHES, LYLEEN P TISH (LAADC,CADC II, CCS,)
Entity Type:Individual
Prefix:
First Name:LYLEEN
Middle Name:P TISH
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LAADC,CADC II, CCS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N STATE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-1485
Mailing Address - Country:US
Mailing Address - Phone:951-652-3560
Mailing Address - Fax:951-929-2780
Practice Address - Street 1:950 N STATE ST
Practice Address - Street 2:SUITE D
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1485
Practice Address - Country:US
Practice Address - Phone:951-652-3560
Practice Address - Fax:951-929-2780
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA333901Medicaid
CA333903Medicaid