Provider Demographics
NPI:1720743891
Name:TRUONG, LILLIE THI
Entity Type:Individual
Prefix:PROF
First Name:LILLIE
Middle Name:THI
Last Name:TRUONG
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 1:1450 E HARMON AVE APT 117B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5946
Mailing Address - Country:US
Mailing Address - Phone:512-748-0638
Mailing Address - Fax:
Practice Address - Street 1:3037 SOFT HORIZON WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1741
Practice Address - Country:US
Practice Address - Phone:702-430-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT2356103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst