NPIMap

Organization Active NPI

Lilac City Behavioral Services, PLLC

Doing business as Lilac City Behavioral

  • Community/Behavioral Health Agency
  • Spokane, WA
National Provider Identifier
1386195279
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LILAC CITY BEHAVIORAL SERVICES, PLLC
Doing business as
Lilac City Behavioral
Practice address
318 E Rowan Ave Ste 201
Spokane, WA 99207-1200
Phone
(509) 844-2429
Fax
(509) 319-2338
NPI assigned
Oct 17, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey Stan Kalles, M.S., BCBANPI 1295113603
Title
Ceo/Member
Phone
(509) 844-4966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

318 E Rowan Ave Ste 201
Spokane, WA 99207-1200

Mailing address

318 E Rowan Ave Ste 201
Spokane, WA 99207-1200
Phone (509) 844-2429

Other identifiers 1

IdentifierTypeStateIssuer
2080619MedicaidWA

Other names 1

  • Lilac City Behavioral Doing business as

National Provider Directory

National Provider Directory

Locations

318 E Rowan Ave
Ste 201
Spokane, WA 99207
Phone (509) 275-8600

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1386195279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 E ROWAN AVE STE 201",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992071200",
            "telephone_number": "509-844-2429",
            "fax_number": "509-319-2338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 E ROWAN AVE STE 201",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992071200",
            "telephone_number": "509-844-2429",
            "fax_number": "509-319-2338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILAC CITY BEHAVIORAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "KALLES",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "STAN",
        "authorized_official_title_or_position": "CEO/MEMBER",
        "authorized_official_telephone_number": "509-844-4966",
        "authorized_official_credential": "M.S., BCBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2080619",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lilac City Behavioral",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lilac City Behavioral",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.