Individual provider Active NPI

Susan F Lilly, M.S., MFT

  • Marriage & Family Therapist
  • Yucca Valley, CA
National Provider Identifier
1437296266
Registry record updated Aug 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFC48278 Issued in CA
Practice address
56244 Papago TRL
Suite#5
Yucca Valley, CA 92284-3285
Phone
(760) 799-2219
NPI assigned
Jan 31, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFC48278 CA Primary

Addresses

Primary practice location

56244 Papago TRL
Suite#5
Yucca Valley, CA 92284-3285

Mailing address

56244 Papago TRL
Suite #5
Yucca Valley, CA 92284-3285
Phone (760) 799-2219

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Jan 30, 2024 through Jan 30, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
MFC48278CAMDMarriage & Family Therapist
1509CAMDCommunity Health/Public Health Clinical Nurse Specialist

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312243200000",
    "number": "1437296266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56244 PAPAGO TRL",
            "address_2": "SUITE #5",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922843285",
            "telephone_number": "760-799-2219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56244 PAPAGO TRL",
            "address_2": "SUITE#5",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922843285",
            "telephone_number": "760-799-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLY",
        "first_name": "SUSAN",
        "middle_name": "F",
        "name_prefix": "Ms.",
        "credential": "M.S., MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2011-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MFC48278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yucca Valley, CA

Sources for this page

Verify at the official NPI Registry.