Provider Demographics
NPI:1871461574
Name:LUJAN, SKYLEE MARIE
Entity type:Individual
Prefix:
First Name:SKYLEE
Middle Name:MARIE
Last Name:LUJAN
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 1:6101 HARRY SMITH RD E
Mailing Address - Street 2:6101 HARRY SMITH RD E
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424
Mailing Address - Country:US
Mailing Address - Phone:253-307-6964
Mailing Address - Fax:
Practice Address - Street 1:950 BROADWAY ST
Practice Address - Street 2:SUITE 301
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:253-671-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-25
Last Update Date:2025-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABACB1459074106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician