Provider Demographics
NPI:1336301621
Name:LILJA, SHANNON M (DBH LPC LMHC CDP CAD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:LILJA
Suffix:
Gender:F
Credentials:DBH LPC LMHC CDP CAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:SANDALWOOD COUNSELING LLC
Mailing Address - City:SKAMOKAWA
Mailing Address - State:WA
Mailing Address - Zip Code:98647
Mailing Address - Country:US
Mailing Address - Phone:503-260-5118
Mailing Address - Fax:
Practice Address - Street 1:818 COMMERCIAL ST STE 305
Practice Address - Street 2:(SECOND OFFICE IN BEAVERTON, OREGON)
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-4553
Practice Address - Country:US
Practice Address - Phone:503-260-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60020400101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist